Paying for your Surgery

Q:  How do I know if my insurance will cover bariatric surgery?

 
A:  In order to confirm whether you have coverage for bariatric surgery or not, you may 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.

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

 A: 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 your surgeon.

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 their 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 to cover the benefit, 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 registering on our Patient Portal, 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.

Costs for each individual surgery will vary. Following your consultation with the surgeon, a financial advisor will meet with you to discuss your financial responsibility for the surgery you and the surgeon agree will be best suited for you. 

Q:  Do you finance surgeries?

A:  Yes! We are excited to offer patients with limited immeidiate cash resources. Upon credit approval, you may qualify for up to $40,000 of credit specific for bariatrics.  This financing avenue offers a broad range of supported credit profiles to assist us with adressing the critical needs of our patients. If you currently have an exclusion on your insurance benefits or if you have a high deductible, go to the website below and apply to get an instant answer to your  application.  

https://secure.springstoneplan.com/ 

 
Q:  What does it mean that The Davis Clinic surgeons are all BLISCare Surgeons?


A:
  Only the BLIS Surgeonsm is able to provide their self-pay patients with financial peace of mind. We understand that as a self-pay patient, should a complication occur, this could be potentiall you devastating to you financially.  While complications are rare, there is always the possibility that a complication could occur, so we've included BLISCare as part of all of our self-pay patient experiences. In order to qualify to become a 'BLIS Surgeon,' physicians must demonstrate a high degree of education, training, experience and commitment to bariatric surgery. In addition, excellent outcomes are required. Each BLIS Surgeon is a 'Center of Excellence' eligible bariatric surgeon with a proven record of successful bariatric surgical outcomes. BLIS surgeons are also required to be part of a comprehensive bariatric program.  BLIS evaluates each surgeon on his or her surgical outcomes and complication rates using a unique and proprietary dataset exclusive to BLIS.

In order to become part of BLIS, we have expressed a clear desire to provide the best care for our patients and have customized our BLISCare plan to meet the specific needs of our patients. As BLIS Surgeons, we have obtained BLISCare in order to help protect you from the potentially devasting financial impact of a post-surgical complication.  We do so knowing no matter how good our outcomes have been, there is always the slight chance that a complication event could occur. Knowing financial protection is in place for our self-pay patients, should it be needed, provides peace of mind for you and your loved ones. Our BLISCare programs come with a 60-day minimum complication coverage period with longer coverage periods available. As a self-pay patient, we will speak with you about the specifics of BLISCare during your initial consultation.

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 (23 cents per mile in 2012)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 February 2012. This amount is subject to change annually.