Getting Started

How to get started

Our program offers two paths — medical weight loss and surgical weight loss — and the steps to get started are different for each. Medical weight loss usually begins with a single consultation. Surgical weight loss follows a more structured process that includes . Review the path that fits your goals below, or contact us and we’ll help you find the best starting point.

How Do I Know if I Am a Candidate For Surgery?

At Cumberland Bariatric Institute, weight loss surgery is done only if a patient meets the following criteria:

  • A Body Mass Index (BMI) of 35 or more. BMI is a simple way to calculate the amount of fat on your body. 
  • The person has already tried non-surgical weight loss treatments such as diet, exercise, and behavioral changes.
  • The person has no medical or hormonal reason for the obesity. These conditions are rare but require treatment of the underlying medical problem.
  • The person must be fully informed about the surgery and have realistic expectations of weight loss and possible complications.
  • The person must demonstrate a willingness to accept the risks of surgery.
  • The person must demonstrate a willingness to make dramatic lifelong changes in lifestyle, dietary habits, and exercise and also commit to medical follow-up.

BMI Calculator

--.-
BMI

Appointment Scheduling

Once insurance review is complete a member of our staff will contact you to set up an appointment for an evaluation. When you attend a seminar at our facility, you will have the opportunity to speak with any number of our bariatric staff, including the surgeon, dietitian, nurses and insurance coordinator(s).

Evaluation

The evaluation appointment is scheduled for about two weeks after we call you. It’s a group meeting with a nurse, dietitian, surgeon and insurance specialist. You’ll also have a one-on-one meeting with the physician assistant for an initial history and physical. After that visit, you will be scheduled for:

  • A nutrition assessment.
  • A psychological evaluation.
  • A weight management program (if your health insurance requires this).
  • Additional medical tests, as determined by the surgeon.
  • You will need to attend a support group. People who have undergone bariatric surgery find it easier to make the necessary lifestyle adjustments when they have the opportunity to meet and talk with other people going through the same experience.
  • Your medical record will be reviewed. After all your tests are completed you will learn whether the clinic’s surgeon/physician assistant has cleared you for surgery.
  • Your case is sent to your insurance carrier for approval.
  • After the insurance company approves the surgery, your pre-operative appointments and surgery will be scheduled.

Insurance & Financing

By using the Insurance Review Form in the Patient Profile Packet, you will know if your policy has benefits for weight loss surgery. If it does and you want to proceed, send in your Patient Profile Packet and the Insurance Review Form. We will screen your health history to make sure you are an appropriate candidate and our Insurance Team will make sure you meet the criteria set forth by your insurance policy. Assuming you meet all criteria, we will call to schedule your first appointment, where you will receive a personalized benefits form that will estimate, to the best of our abilities, your total out-of-pocket expenses. You will also need to complete a seminar, either in-person at our facility, or online.

Surgical Weight Loss Insurance FAQs

Most insurance plans require that your BMI be 35 or higher. However, if your BMI is between 30 – 35, many insurance providers will also accept/cover services if you have a life-threatening medical condition, such as high blood pressure, diabetes or sleep apnea.

Does my insurance have benefits for weight loss surgery?

For commercial insurance policies, contact the customer service number on the back of your insurance card and ask this question exactly: “In my certificate of coverage are there benefits for weight loss surgery for morbid obesity if medically necessary?”

For Medicare and Medicaid, there are benefits for weight loss surgery as long as the criteria is met. There is no need to contact Medicare and Medicaid.

If I meet the co-morbid and BMI requirements, do I still have to do a diet?

Most insurance companies that require a diet still require the diet no matter how many co-morbid diagnoses you have.

If my doctor writes a letter saying I really need the surgery, do I still have to diet?

Yes, the diet is part of criteria set by your insurance company. Your physician can write you a letter of support which will assist in obtaining approval, but you still have to complete the diet.

My co-worker/friend started the same time I did. Why are they moving through the process faster than me?

This is a question that is asked a lot. Sometimes additional testing is required, one primary care may get the documentation back faster, or if your friend has a different insurance than you, maybe you were required to do a diet and your friend was not. If the insurances are different, then it may be because one insurance just takes longer to process than the other.

My insurance says I need a medically supervised diet. What does that mean?

Usually the diet must be for at least 6 full months, which is one initial visit and 6 follow-up visits. Your appointments must be consecutive and the diet must be successful, meaning your end weight must be the same or less than your start weight.

What if my insurance says there is an exclusion in my policy?

This means that your particular plan does not have benefits for weight loss surgery, no matter if you meet the medical necessity requirements or not. Your insurance may tell you that you have appeal rights. Keep in mind that you will be appealing policy and not medical necessity. If there are no benefits for weight loss surgery, it basically means that the benefit was not purchased by your company.

If my insurance will not pay for the surgery, can I pay for the surgery myself?

We do offer bariatric surgery for patients who would like to pay out-of-pocket. Please contact us directly for a quote.

What kinds of medications and/or vitamins will I need to take after surgery?

Many patients are able to stop using some medications such as those for diabetes or high blood-pressure if these health issues are directly related to their weight. It is recommended that bariatric surgery patients maintain a vitamin regimen indefinitely after their procedure.

My question about insurance wasn't addressed…
Please send an email to our coordinator at Myra.Frye@LPNT.net.