Q: Who do I call to confirm that my insurance covers weight loss (bariatric) surgery?

A:  In order to confirm whether you have coverage for bariatric surgery or not, you should call the customer service number on the back of your insurance card. Simply ask if you have coverage for bariatric surgery – do not give specific CPT or diagnosis codes.

If your insurance provider indicates that you have coverage “if it is deemed medically necessary,” this means that you have benefits for weight loss surgery. The insurance experts at our office will verify the specific benefits you have and will go over all of the specifics about your insurance coverage and the requirements for approval for surgery when you meet with us at your first consultation with Dr. Davis.

If your insurance provider indicates that you have an “exclusion” on your policy, this means that your employer has opted not to cover this benefit for employees. Unfortunately, if you have an exclusion, letters or appeals from our office will not change whether or not you have this benefit on your policy. Only your employer can make this change by choosing to cover bariatric surgery as a benefit to its employees.

If you have an exclusion, we recommend that you to speak with your human resources director and ask if there may be plans to cover this benefit in the coming year. We have had several patients in our program convince their employers that the benefits of weight loss surgery – including getting off of their expensive medications rather quickly, missing less time off from work due to related conditions and illnesses, and generally being more productive due to a more positive outlook on life – outweighed the cost and they were successful in gaining coverage.

Q:  How much does the surgery cost if my insurance will not pay for it?

A:  Because we believe it’s important to use your insurance benefits if you have them, the first step is to allow our insurance specialists to verify your specific benefits. They have extensive knowledge and expertise with bariatric insurance verification, pre-certification, and approval. Upon joining The Davis Clinic program, we will verify your benefits and will be happy to speak with you about the options available if you do not have coverage for weight loss surgery.

Because cost variables exist with each procedure and with each hospital where we perform surgery, we are unable to give out specific pricing until we have seen you in our office and you and Dr. Davis determine the type of surgery that’s right for you.

Q:  I have no health insurance coverage and want to know the cost of the procedure. Can you tell me how much it costs if I pay for my weight loss surgery myself?

A:  We have relationships with several medical financing companies if you do not have insurance benefits and are interested in paying for your weight loss surgery. Our bariatric patient coordinator can discuss the cost of the procedure with you at your first consultation, as cost varies slightly by hospital location and on the procedure you will undergo.

Medical financing companies allow you to make monthly payments so that you can pay for your weight loss surgery over time. This makes having the surgery you need easy to obtain.

Q:  If I use a finance company and get a surgical loan, what will my monthly payment be?

A:  Your monthly payment will be determined by several factors, including the cost of your procedure, the term of the loan (how many months you will pay), and your interest rate.

As an example to go by, if you have an excellent credit rating, you may be able to get an interest rate of around 10%. If your surgery costs $15,000, and you sign a five-year loan (60 months) with a 10% interest payment, your monthly payment will be around $320.00. While this may sound like a lot, if you put it in perspective, this is just a little over $10.00 per day. Of course, if you have a higher interest rate, your monthly payment will be more. If you have a lower interest rate, your monthly payment will be less.

Good resources for medical financing information include:

Q:  If I pay for surgery myself, are there any tax deduction benefits?

A:  In the year you finance or pay cash for your bariatric (weight loss) surgery, you may be eligible to receive money back in potential tax savings. IRS Publication 502 states you can deduct your medical and dental expenses when they total more than 7.5% of your Adjusted Gross Income (see IRS publication 502, page 2—http://www.irs.gov/pub/irs-pdf/p502.pdf). 
 
Although the processes of calculating tax deductions are by no means precise and can be quite complex, you may be able to deduct a portion of your medical expenses, including the costs associated with your weight loss surgery. The deduction is designed so that your taxable income is reduced to the extent your medical expenses exceed a percentage of your adjusted gross income. Many non-reimbursed medical expenses, including bariatric surgery, medications, and other medical services exceeding 7.5% of a taxpayer’s adjusted gross income, are tax deductible. See the list below for just some of the examples of potential tax savings. Be sure each medical expense you consider as a deduction meets the IRS requirements of a tax deduction. Common medical expenses that are not deductible include most cosmetic surgery, nutritional supplements, non-prescription drugs, and teeth-whitening expenses.

The rules for tax deductions for medical expenses are established by the Internal Revenue Service and explained in Publication 502. For additional information, visit www.irs.gov or call 1-800-829-1040 to reach the Internal Revenue Service. Always speak with your tax advisor regarding tax issues.

Remember, tax and financial circumstances are different for each person and the laws are constantly changing. This information should be not be considered financial advice or used as a substitute for the advice of an accountant or tax advisor. You should seek financial advice from a professional for any questions about medical tax deductions that you may have.

To maximize the Medical Expenses Tax Deduction on your personal tax return, be sure to include the following expenses:

•  All medical expenses, including most dental expenses, for everyone listed on your tax return (your spouse and dependents)
•  Costs of medically-supervised weight loss programs (but not the cost of low-calorie food). To justify the deduction, your doctor must recommend participation in a weight loss program to reduce health risks.
•  Insurance payments paid with taxed income
•  Uninsured medical expenses including eyeglasses, contact lenses, and hearing aids
•  Prescription drug costs not covered by insurance, and co-payments for medications covered by insurance
•  Travel expenses to and from medical treatments, calculated by using standard mileage rates, set each year by the IRS (14 cents per mile in 2004, 15 cents per mile in 2005, 20 cents per mile in 2007, and 19 cents per mile in 2008)¹
•  Medically necessary costs prescribed by physicians
•  The cost for corrective eye surgery

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¹ Mileage deduction is based on information acquired at www.irs.gov in July 2009. This amount is subject to change annually.