Horizon NJ Health is a Medicaid plan which covers weight loss surgery. Fortunately the fees for weight loss surgery are lower for Medicare patients and you will only be charged the amount Medicare would have paid us. If we feel that Medicare may not cover your surgery, you can still proceed with the treatment but you will have to sign an Advanced Beneficiary Notice (ABN) which will make you responsible for our fees in case Medicare declines to pay. However, we generally will have an idea whether your bariatric surgery will be covered by Medicare or not based on your weight and health conditions. Medicare does not have a pre-certification process, which means they do not tell us in advance whether they will pay for your weight loss surgery or not. Medicare does not require you to go through a medically supervised weight loss program prior to the surgery. Medicare will not cover your weight loss surgery if you only have obesity, no matter how heavy you are. In general, Medicare will cover bariatric surgery if your BMI (Body Mass Index) exceeds 35 and you have two of the following conditions: hypertension, diabetes, osteoarthritis, sleep apnea, or hypercholesterolemia. The good news is that most insurance companies will ultimately cover weight loss surgery if you meet their criteria. Many patients feel very frustrated that they have to "jump through the hoops" to get their weight loss surgery but we can not do anything about the rules each individual insurance company imposes. Insurance companies will most likely authorize your procedure if you comply with their requirements. Your visits will be set up by our office. Some insurance companies will require patients to undergo several office visits before qualifying for Bariatric Surgery. This is done for each individual policy holder, as benefits can vary from plan to plan. Our surgical coordinator, JoAnn, then submits a letter of pre-determination to your insurance carrier to verify that benefits are available for this procedure. Gritsus documents all pertinent medical information in the patient’s chart. Gritsus participates in New Jersey Medicaid plans such as Horizon NJ Health and Amerigroup.Īfter the first consultation has been performed, Dr. is an in-network provider with Aetna, Cigna, Horizon, Oxford, Medicare, AmeriHealth, Amerigroup, Horizon NJ Health, United Healthcare, HealthNet and many other insurance plans.ĭr. They will be making you healthier and that will benefit them as well.įor general surgical procedures such as hernia repair, cholecystectomy, or endoscopy, there are generally no exclusions. If your plan has an exclusion on bariatric surgery you may want to talk to your employer and ask them to include the coverage for weight loss procedures in your plan. This is wrong and descriminatory but not illegal, since self insured plans operate by a different set of rules than regular commercial insurance plans. Bariatric surgery can be one of these conditions. Frequently, coverage of certain conditions may be excluded by choice of the employer.
For example, a company such as Verizon or ATT will self-insure their employees instead of purchasing coverage from a third party such as Aetna, Cigna or Horizon. Those plans are generally administered by large corporations for their employees. Most of the exclusions are in what is called "self insured" or "self guided plans". Although most of the plans cover Bariatric Surgery, there are still some insurance providers which have exclusions. Gritsus, we recommend that you call your insurance company and ask whether you have coverage for Bariatric Surgery. *The below list of providers actively participates with United Community Managed Medicaid plans:Our practice will help you to qualify with your insurance company for treatment you need and deserve.īefore you schedule your consultation with Dr. We are not in-network with Americhoice, Community Plan = Medicaid, Compass Plans, Essential Plan (United CityMD Essential Plan), Medicare Dual Complete, UHC Core. *The below list of providers actively participates with Horizon Health of NJ Managed Medicaid plans: We are not in-network with ALL NJ Family Plans, Horizon NJ Health, Horizon NJ Total Care, NJ Family Care. *The below list of providers actively participates with AmeriGroup plans: Check with your insurance company to determine if the provider participates in your plan. Limited participation in Medicaid Managed Care coverage for select providers.
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