Blog

11/12/2024 by DrCurry

Semaglutide special at JourneyLite!

Don't wait, get started now!

You can use your HSA or Flexible Healthcare Spending Account!

Too many Holiday parties lead to a bump up in the scale? The New Year is a great time to get focused on healthier eating and exercise to shed those extra end-of-the-year pounds! Sometimes, though, this isn’t enough to get the scale moving in the right direction. At JourneyLite Physicians, we have a strong GLP-1 program with experienced medical providers and licensed/registered dietitians. We also use a trusted, vetted compounding pharmacy partner (MediVera – formerly University Compounding Pharmacy) to provide compounded semaglutide injections shipped directly to your home.

To help you with achieving your weight loss goals, for a limited time we are offering a 3-month complete semaglutide program for $900! This includes all of your provider+dietitian visits, medication, and shipping costs. Take advantage of this New Year savings to get the scale moving in the right direction now before the spring gets here! This can also be a great option for post-op patients who just need a jump-start to get back on track.

Don’t use some faceless online company to help you with your weight loss needs, choose your trusted weight loss partner, JourneyLite! Just fill out the no-obligation appointment request form below and one of our patient service representatives will contact you with all the details and answer any questions you might have.

Note: Program cost is non-refundable, but can be transferred to other products and/or services. Pricing is for a limited time, subject to change without notice. Offer valid in Cincinnati, Columbus, Dayton, Northern Kentucky, and Indianapolis locations. Starting programs only–does not apply to patients already on a GLP-1 medication.

04/12/2024 by DrCurry

LINX Procedure for Gastric Sleeve Patients with GERD

Treatment of reflux after gastric sleeve with the LINX procedure

Gastroesophageal reflux disease (GERD) can sometimes be an issue for patients who have undergone a gastric sleeve procedure. In the past, sleeve patients experiencing severe symptoms sometimes had to be converted to a gastric bypass to control their GERD. However, a new procedure called the LINX Reflux Management System offers a promising new solution for managing GERD symptoms in these patients.

Why is reflux after gastric sleeve common?

Gastric sleeve surgery, or sleeve gastrectomy, involves removing a large portion of the stomach, which can lead to changes in the pressure dynamics of the LES. This can result in an increased risk of acid reflux and GERD symptoms.

What is the LINX Procedure?

The LINX system is a small, flexible ring of magnetic titanium beads that is surgically placed around the lower esophageal sphincter (LES). This device helps to reinforce the LES, preventing stomach acid from flowing back into the esophagus while allowing food and liquids to pass through normally.

Benefits of the LINX Procedure for Reflux after Gastric Sleeve

1. 1. Minimally Invasive: The LINX procedure is performed laparoscopically, which means it involves small incisions and typically results in a quicker recovery time compared to traditional surgery.
1. 1. Effective Symptom Relief: Studies have shown that the LINX system can significantly reduce GERD symptoms. For example, a clinical trial found that 85% of patients no longer needed daily proton pump inhibitors (PPIs) one year after the LINX procedure.
1. 1. Preservation of Normal Functions: Unlike some other surgical options, the LINX device allows patients to belch and vomit normally, which is important for overall digestive health.
1. Reversible: The LINX device can be removed if necessary, providing flexibility for future treatment options.

Considerations and Risks

While the LINX procedure offers many benefits, it is important to consider potential risks and complications. These can include difficulty swallowing, post-operative pain, and the possibility of the device eroding into the esophagus. However, these risks are generally low, and the procedure has been shown to be safe and effective in clinical trials.

Conclusion

For gastric sleeve patients struggling with GERD, the LINX Reflux Management System provides a viable and effective treatment option. By reinforcing the LES and preventing acid reflux, the LINX device can significantly improve quality of life and reduce the need for daily medication.

If you are considering the LINX procedure, it is important to discuss it with your healthcare provider to determine if it is the right option for you.

: Ethicon | J&J MedTech
: Mass General
: Gastric Sleeve Center

31/10/2024 by DrCurry

Is weight loss surgery tax deductible?

Many patients ask the question – Is weight loss surgery tax deductible?

This is a question that we actually do not get asked very often because many patients think that if their insurance isn’t covering a procedure that it isn’t medically necessary. In actuality, whether a treatment is covered or not has nothing to do with medical necessity – that is something that is determined by your physician! Even if your insurance is covering your procedure, especially if you have a higher deductible plan, you may still qualify. Keep on reading to find out more!

Understanding the Tax Deductibility of Weight Loss Surgery

Weight loss surgery, also known as bariatric surgery, can be a significant financial investment. Especially if you are self-paying for a procedure such as a gastric sleeve or bypass! However, many people may not realize that some of these expenses can be tax-deductible, potentially easing the financial burden. Here’s a comprehensive look at how you can leverage tax deductions for weight loss surgery.

Eligibility for Tax Deduction

To qualify for a tax deduction, weight loss surgery must be deemed medically necessary. This means that the surgery is not elective but is required to treat a specific medical condition, such as obesity, which is recognized as a disease by the IRS ¹. The surgery must be prescribed by a physician and aimed at treating or preventing a disease. At JourneyLite this will always be the case!

Qualifying Expenses

The IRS allows you to deduct medical expenses that exceed 7.5% of your adjusted gross income (AGI). For example, if your AGI is $50,000, you can deduct medical expenses that exceed $3,750 ². Qualifying expenses include:

Surgery Costs: The cost of the surgery itself, including hospital fees and surgeon fees.
Pre- and Post-Operative Care: Expenses related to consultations, follow-up visits, and necessary medical tests.
Prescription Medications: Any medications prescribed as part of the treatment plan.
Travel Expenses: Transportation costs to and from the medical facility, including mileage, tolls, and parking fees ².

Non-Qualifying Expenses

Certain expenses related to weight loss surgery are not deductible. These include:

Diet Foods: Costs for special diet foods that substitute for normal meals.
Health Club Memberships: Membership fees for gyms or health clubs, unless prescribed by a doctor for a specific medical condition ³. In many cases our team will be able to write a letter to get these expenses included, however we recommend having a CPA review the information first!

How to Claim the Deduction

To claim the deduction, you must itemize your deductions on Schedule A (Form 1040). Here’s a step-by-step guide:

Gather Documentation: Collect all receipts, bills, and documentation related to your medical expenses.
Calculate Total Medical Expenses: Add up all qualifying medical expenses.
Determine Deductible Amount: Subtract 7.5% of your AGI from your total medical expenses to find the deductible amount.
Complete Schedule A: Enter the deductible amount on Schedule A (Form 1040) under medical and dental expenses ¹.

Conclusion

Understanding the tax deductibility of weight loss surgery can help you manage the financial aspects of your health journey. By ensuring that your surgery is medically necessary and keeping thorough records of your expenses, you can take advantage of potential tax savings.

If you have any specific questions or need further assistance, consulting a tax professional or the IRS guidelines can provide additional clarity.

¹: IRS Publication 502 ²: IRS Topic No. 502

Feel free to ask if you need more detailed information or have other questions!

23/10/2024 by DrCurry

Bariatric surgery vs. GLP-1’s, which is better?

Bariatric surgery vs. GLP-1’s is a hotly-debated topic today. Surgical procedures such as gastric sleeve and gastric bypass, have long been recognized as effective tools for significant and sustained weight loss. In recent years, GLP-1 receptor agonists, a class of medications that includes drugs like semaglutide (Ozempic, Wegovy) and tierzepatide (Mounjaro, Zepbound), have emerged as a popular non-surgical alternative for weight loss and type 2 diabetes management. However, recent studies and cost-effectiveness analyses suggest that bariatric surgery may provide more lasting and cost-efficient results compared to GLP-1 medications over the long term.

The Rise of GLP-1 Receptor Agonists

GLP-1 (glucagon-like peptide-1) receptor agonists work by mimicking the action of the GLP-1 hormone, which helps regulate blood sugar and appetite. These drugs have gained considerable attention due to their dual benefits: improving glycemic control for individuals with type 2 diabetes and promoting significant weight loss in people with obesity. Semaglutide, in particular, has shown dramatic results in clinical trials, with some patients losing up to 15% of their body weight.

However, despite the clinical efficacy of GLP-1 receptor agonists, they come with significant financial costs. Long-term use of these medications requires ongoing prescriptions, and depending on insurance coverage, patients may face high out-of-pocket expenses. For instance, the cost of semaglutide can reach upwards of $1,000 per month, making it a costly lifelong intervention.

Bariatric Surgery: A Proven, One-Time Solution

Bariatric surgery, including procedures like gastric bypass, sleeve gastrectomy, and adjustable gastric banding, has been a cornerstone of obesity treatment for decades. Unlike GLP-1 medications, which require continued use, bariatric surgery is a one-time procedure that offers sustained weight loss and improvement in obesity-related comorbidities such as diabetes, hypertension, and sleep apnea.

According to data from long-term studies, bariatric surgery can result in weight loss of 25-30% of total body weight, which is significantly higher than the average weight loss achieved with GLP-1 medications. Furthermore, the metabolic changes induced by surgery, particularly in procedures like gastric bypass, can lead to the remission of type 2 diabetes in many patients, further reducing healthcare costs associated with managing the disease.

The Cost-Effectiveness Analysis

A growing body of research has compared the cost-effectiveness of bariatric surgery and GLP-1 receptor agonists. The findings consistently show that bariatric surgery is more cost-effective in the long run due to its durability and one-time cost structure. A study published in JAMA Surgery in 2023 revealed that, over a 10-year period, patients undergoing bariatric surgery had significantly lower healthcare costs compared to those using GLP-1 medications, even when considering the upfront costs of surgery. Also, recent 2024 data published out of Northwestern University found that weight loss surgery saves patients an average of about $9000 a year and delivers 2 additional years of healthy life over GLP-1’s.

The cost savings stem not only from weight loss but also from the resolution or improvement of obesity-related conditions, particularly type 2 diabetes. Bariatric surgery has been shown to reduce or eliminate the need for diabetes medications, including insulin, in many patients. In contrast, GLP-1 receptor agonists, while effective, require continuous use, and their benefits may wane if the medication is discontinued.

Quality of Life and Long-Term Outcomes

In addition to cost, quality of life (QoL) improvements are a critical factor when evaluating treatments for obesity and related conditions. Both bariatric surgery and GLP-1 medications have been shown to enhance QoL by reducing body weight, improving mobility, and decreasing the burden of comorbidities. However, bariatric surgery’s more significant and sustained weight loss often leads to greater improvements in physical and mental health.

Studies have also suggested that bariatric surgery may have a more profound impact on long-term mortality and morbidity. A 2019 meta-analysis found that bariatric surgery reduced the risk of all-cause mortality by nearly 50%, compared to non-surgical interventions. The long-term benefits of surgery in reducing cardiovascular disease, cancer, and diabetes complications contribute to its favorable cost-effectiveness profile.

Challenges and Considerations

Despite its advantages, bariatric surgery is not without challenges. It is an invasive procedure with potential risks, including surgical complications, nutritional deficiencies, and the need for lifelong medical monitoring. Additionally, not all patients are eligible or willing to undergo surgery. Meanwhile, GLP-1 receptor agonists provide a non-invasive option, making them attractive to individuals who prefer to avoid surgery or who may not qualify for surgical interventions.

There is also the issue of accessibility. Bariatric surgery, while cost-effective over time, requires a significant initial investment, and not all insurance plans cover the full cost of the procedure. On the other hand, GLP-1 medications are more readily accessible but may become prohibitively expensive without insurance or discounts.

The Future of Obesity Treatment

As obesity rates continue to rise globally, healthcare systems must carefully consider both the clinical outcomes and economic impact of treatments. While GLP-1 receptor agonists offer an exciting pharmacological option for weight loss, bariatric surgery remains the gold standard for achieving significant and sustained weight reduction and resolving related comorbidities.

For many patients, bariatric surgery may offer a more cost-effective solution over time, especially when taking into account the reduced need for medications and healthcare interventions. However, the choice between surgery and medication should be tailored to the individual, factoring in their health status, preferences, and ability to afford long-term treatments.

As research progresses, it is likely that the optimal strategy for obesity management will involve a combination of medical, surgical, and behavioral interventions to ensure the best possible outcomes for patients.

Conclusion

Bariatric surgery has been shown to be a more cost-effective approach than long-term use of GLP-1 receptor agonists for weight loss and the treatment of type 2 diabetes. While GLP-1 medications offer a non-surgical alternative with significant short-term benefits, the one-time cost and lasting effects of bariatric surgery make it a superior option for many individuals struggling with obesity and its related health issues. The decision between the two should ultimately be personalized, balancing cost, efficacy, and patient preference to optimize outcomes in the fight against obesity. Fortunately, our team at JourneyLite offers a wide range of treatments including medications, surgical procedures, and non-surgical options such as gastric balloon. Schedule a consultation with our team to find out which option is best for you!

Request Appointment!

22/10/2024 by DrCurry

Unlock Your Weight Loss Potential with JourneyLite’s GLP-1 Program!

Tired of diets that don’t work? Struggling with weight management? At JourneyLite, we’re here to help you reach your health and weight loss goals with a groundbreaking approach using GLP-1 medications.

Our GLP-1 program features safe, effective, and FDA-approved treatments like Tirzepatide and Semaglutide that are designed to help you lose weight and improve your overall health. These medications target key areas in your body that regulate hunger and blood sugar, making it easier than ever to:

🌟 Lose Weight
🌟 Control Cravings
🌟 Boost Energy Levels
🌟 Improve Your Metabolic Health

Why Choose JourneyLite?

✅ Medical Supervision: Our experienced team of medical providers and registered dietitians offers personalized care and guidance every step of the way.
✅ Proven Results: Patients see real, sustainable weight loss with GLP-1 treatments.
✅ Comprehensive Support: From meal planning to fitness advice, we help you build healthy habits that last.

Join the thousands who have transformed their lives with JourneyLite’s GLP-1 program! Take the first step to a healthier, happier you today.

Schedule your consultation now and take advantage of our 3 month semaglutide special for $900 – includes all visits, medication, and shipping cost!

Book now!

Offer good until 12/31/2024 only.

10/10/2024 by DrCurry

FDA Removes Tirzepatide from Shortage List

surgeon-circle — Dr. Trace Curry
Medical Director
JourneyLite

27/09/2024 by DrCurry

5 Reasons Weight Loss Surgery Beats GLP-1’s

Dr. Trace Curry
Medical Director
JourneyLite

We know that weight loss surgery is superior to GLP-1’s for many overweight patients, so I thought I would compile a list of 5 reasons why weight loss surgery beats GLP-1’s (GLP-1 receptor agonists, or GLP1RA’s). As a weight loss specialist treating patients for over 20 years with both medications, surgeries, and procedures such as gastric balloon, there has never been a time where patients had more options to investigate to help them lose weight. Unfortunately, sometimes more options bring more confusion in terms of the best path for somebody who wants to knock out some unwanted pounds. So lets try to make a clearer picture out this crowded field of options!

GLP-1 receptor agonists such as Wegovy, Ozempic, Zepbound, and Mounjaro are in the news every day. Will these medications cause weight loss surgery to become obsolete? The answer is no, according to a lot of current data including some unveiled at a recent poster presentation at the American Society of Bariatric Surgery. The presenters looked at ~25,000 gastric sleeve/gastric bypass patients and compared the results to around 12,000 patients being treated with semaglutide and 3200 patients on tirzepatide.

After analyzing these results, here are 5 reasons that, for some patients, weight loss surgery is better than GLP-1 receptor agonists.

Amount of weight loss
- In the lifestyle-only group, meaning they did not receive and medications or surgery, patients lost a mean total body weight loss of 7.4%. Patients universally regained weight with time and went back to their pre-intervention weight within around 4 years.
- In the GLP-1 group:
  - Treatment with semaglutide weekly injections for 20 weeks resulted in a mean total body weight loss of 10.6%
    - Percent total body weight loss is calculated by multiplying the percentage loss by the patient’s weight. So if you’re 300 lbs and you lost 10% of your total body weight, that would be 250 x .10 = 25 lbs
  - Treatment with weekly tirzepatide injections for 36 weeks yielded a mean total body weight loss of 21.1%
  - While this seems promising on the surface, about half of the weight was regained within a year after stopping the injections, whereas continuing the medications indefinitely provided little additional weight loss.
    - Even if the 250 lb patient continues the medication, the thought of injecting yourself with a ~$1000/month medication weekly for the rest of your life to maintain a 25 lb weight loss is daunting!
- In the surgical group, outcomes were significantly better:
  - Gastric bypass and sleeve gastrectomy resulted in a mean 1-year total body weight loss of around 32% and 30% respectively.
Long-term success rate
- GLP1-RA’s
  - We have seen in multiple studies that nearly all patients will regain any weight lost on a GLP1RA when the medication is stopped.
  - This means that, to have any chance for long-term weight loss, you are committing to injecting yourself for the rest of your life.
  - A recent study by Blue-Cross/Blue-Shield showed that 58% of patients didn’t even complete a 12-week course of GLP1RA’s.
- Surgery
  - Incredibly, they were able to extract data out to 10 years, which showed durable long-term weight loss of 25% total body weight loss.
Cost
- GLP1-RA’s
  - The cost of GLP1RA’s both to individual patients and society in general is enormous:
    - Estimates are that it would cost the health care system around $600 billion a year to treat all eligible patients with GLP1RA’s.
    - For individuals, the cost of brand-name medications such as Wegovy or Zepbound out-of-pocket can be $500-$1200/month.
    - Even for compounded versions of semaglutide and tirzepatide, the cost is $300-$500/month including office visits required for the prescriptions.
  - Few healthcare plans cover GLP1RA’s for weight loss. Medicare and Medicaid do not.
  - Surgery
    - Weight loss surgery is covered by Medicare, Medicaid, any most commercial carriers.
      - Coverage is determined by employers, not by commercial carriers.
      - With employer-directed healthcare plans like Surgery Plus, Luminary, Barinet, and Carrum patients can have weight loss surgery with little-to-no out-of-pocket cost.
    - For self-pay patients, gastric sleeve can be found in many parts of the country for as little as $10,000.
Side effects
- GLP1-RA’s
  - There are many side effects from these medications, such as nausea, vomiting, reflux, constipation, and gastroparesis.
  - In rare cases, these medications have been associated with serious thyroid cancers
- Surgery
  - Gastric sleeve and gastric bypass carry well-defined risk.
  - Unlike for medications, most side effects after surgery such as pain, nausea, and vomiting are temporary and resolve after a few weeks.
One-time Procedure
- Although we are talking about a surgical procedure instead of injections, it is a one-time procedure which for many patients is much more appealing than a daily or weekly injection for the rest of their lives.

There are more than 5 reasons weight loss surgery beats GLP-1’s, however, as with any surgical procedure or medication, you should talk to your doctor about your specific case and what any risks, benefits, and costs would be. At JourneyLite, we have a comprehensive team of weight loss specialists and Registered Dietitians with extensive experience in medications, weight loss surgery, and non-surgical procedures such as gastric balloon.

If you would like to make an appointment to discuss these options with me, or my associate Dr. James Augusta, just click on the appointment button below!

30/08/2024 by DrCurry

Vitamins after weight loss surgery: 90 days and beyond

Pharmaceutical-grade vitamins are critical to avoid vitamin deficiencies after weight loss surgery. At JourneyLite Physicians, we carry only Bariatric Advantage vitamins, the industry standard for vitamin quality and effectiveness for bariatric surgery patients. Did you know that your vitamin regimen changes when you are 90 days post-op?

To make this simpler for our patients, we have assembled vitamin kits for each procedure! Just click on the link below for your specific surgery to learn more; also listed below is an optional biotin supplement which can help prevent post-op hair loss.

*Each vitamin kit provides a 90-day supply for your specific procedure. If you check out with Paypal, deferred payment options are available!

14/08/2024 by DrCurry

Semaglutide special at JourneyLite!

Did too many summer barbeques and cocktails lead to a bump in the scale over the summer? The kids are going back to school and it’s time to get back into your regular routine of healthier eating and regular exercise! Sometimes, though, this isn’t enough to get the scale moving in the right direction to shed those summer party pounds. At JourneyLite Physicians, we have a strong GLP-1 program with experienced medical providers and licensed/registered dietitians. We also use a trusted, vetted compounding pharmacy partner (MediVera – formerly University Compounding Pharmacy) to provide compounded semaglutide injections shipped directly to your home.

To help you with achieving your weight loss goals, for a limited time we are offering a 3-month complete semaglutide program for $900! This includes all of your provider+dietitian visits, medication, and shipping costs. Take advantage of this back-to-school savings to get the scale moving in the right direction now before the holidays get here!

Note: Program cost is non-refundable, but can be transferred to other products and/or services. Offer good for appointment requests received by 9/30/2024. Offer valid in Cincinnati, Columbus, Dayton, Northern Kentucky, and Indianapolis locations. Starting dosages only–does not apply to patients already on semaglutide.

24/05/2024 by outerboxseo

Does Insurance Cover Weight Loss Surgery?

When considering weight loss surgery, one of the most pressing questions on many people’s minds is, “Does insurance cover weight loss surgery?”

As obesity rates continue to climb globally, weight loss surgeries such as gastric bypass, lap band, and gastric sleeve procedures have become critical tools in managing severe obesity and related health conditions. These surgeries help reduce weight and improve various obesity-related health issues like diabetes, hypertension, and sleep apnea, highlighting their medical necessity.

Given the significance and potential health benefits of these procedures, understanding insurance coverage is essential for anyone considering surgical options for weight management. This article will explore whether insurance covers weight loss surgeries, reviewing the specifics of coverage, requirements, and how to handle potential denials.

on this page

Associated Costs
Is Weight Loss Surgery Covered?
Coverage Requirements
What Companies Provide Coverage?
If Your Claim Is Denied
Insurance Coverage Alternatives
Frequently Asked Questions

How Much Does Weight Loss Surgery Cost?

Before we examine whether insurance covers bariatric surgery, we should discuss the associated costs. The cost of weight loss surgery ranges into the tens of thousands of dollars and can extend well beyond the initial surgical procedure. Typically, these costs include:

Surgical fees
Hospital charges for the room and nursing care during the stay
Anesthesia fees
Expenses related to post-operative follow-up care, which is crucial for monitoring recovery and ensuring the success of the surgery

In addition to these direct surgical costs, patients must also consider additional expenses that are often not covered by insurance. For instance, most weight loss surgery patients require ongoing nutritional counseling to help them adapt to their new dietary requirements and ensure they receive adequate nutrition.

Many patients also must take lifelong supplements, such as vitamins and minerals, to compensate for the reduced ability to absorb nutrients following procedures like gastric bypass. These supplements and the cost of dietary consultations can represent a significant part of the post-surgery expenses.

Understanding these costs is vital, as they impact your overall investment in your health and well-being.

Although insurance charges vary greatly depending on each contract, JourneyLite believes in transparent pricing for self-pay patients and provides a comprehensive outline of your overall costs so you can clearly understand your financial obligation. For insurance patients, our team can estimate your out-of-pocket expenses once we analyze your policy and coverage benefits.

Does Insurance Cover Weight Loss Surgery?

The short answer is “sometimes.” Certain insurance plans will cover weight loss surgery if it’s deemed medically necessary. This may include insurance coverage for gastric sleeve, lap band, or gastric bypass procedures.

does insurance cover gastric sleeve lap band gastric bypass

Significant Differences in Coverage

Weight loss surgery coverage can vary significantly among different providers and plans. But many health insurance policies commonly cover several aspects of weight loss procedures. Typically, insurance will cover the major expenses of the surgery itself, including hospital stays, surgeon’s fees, and anesthesia, provided that the surgery is deemed medically necessary. This determination of medical necessity usually requires documentation from healthcare professionals indicating that the surgery is essential for the treatment of obesity-related health conditions that could be life-threatening if left untreated.

Varying Coverage for Procedures

The extent of coverage can differ significantly. Some insurance companies may cover all types of weight loss surgeries. In contrast, others might only cover specific procedures like gastric bypass or sleeve, excluding others such as adjustable gastric banding. Additionally, coverage might include all associated hospital charges for the duration of the stay required by the surgical procedure, but this, too, can vary. Each insurance provider has its own criteria for eligibility and coverage, including different deductible levels, co-payments, and out-of-pocket maximums that can affect your overall cost.

The Need for Reviewing Coverage

Patients considering weight loss surgery should closely review their insurance plan or speak directly with their insurance provider to understand what is covered. Our team of professionals can also help you determine what is covered. Reviewing your coverage is essential for financial planning and to ensure there are no surprises during the billing process after the surgery has been completed.

Insurance Coverage Requirements for Weight Loss Surgery

Although each plan differs, securing insurance coverage for weight loss surgery often involves meeting a set of stringent criteria established by insurance companies. One of the primary requirements is related to body mass index (BMI). Typically, insurance providers require a BMI of 40 or higher, which indicates severe obesity. Alternatively, a person with a BMI of 35 to 39.9 may also qualify if they have significant obesity-related health conditions, such as hypertension, type 2 diabetes, or severe sleep apnea.

what insurance companies cover weight loss surgery

Additional Documentation

Beyond BMI, insurance companies usually require documented evidence of weight-related health issues that could improve with surgery and a history of previous weight loss attempts through non-surgical methods like diet, exercise, and perhaps medical therapy, proving that other methods have been ineffective over a significant period. This documentation often includes detailed medical records, a physician’s recommendation, and sometimes a psychological evaluation to assess the patient’s mental readiness and support system for post-surgery lifestyle changes.

Preoperative Testing

Additionally, prospective patients are typically required to undergo several preoperative medical assessments to ensure they are fit for surgery. These assessments might include lab tests, heart and lung evaluations, and consultations with nutritionists and psychologists. Gathering and presenting this comprehensive documentation is crucial to demonstrate the necessity of the surgery and facilitate the approval process with your insurance provider.

What Insurance Companies Cover Weight Loss Surgery?

Many major insurance companies provide coverage for weight loss surgery, but the specifics of this coverage differ based on state regulations and individual policies. Examples of health insurance plans accepted by JourneyLite include:

Aetna
Anthem/Blue Cross-Blue Shield
Cigna
Humana
Medical Mutual
Surgery Plus
Transcarent
United Healthcare

Our expert patient service representatives can help you explore your options and provide useful tips for pursuing insurance coverage for your weight loss surgery.

What To Do if Your Claim Is Denied

If your insurance claim for weight loss surgery is denied, it’s essential to understand that you can appeal the decision. Initially, you should request a detailed explanation of the denial from your insurance provider. This information is crucial as it will guide your next steps and help you address specific reasons cited for the denial.

Review the Denial Letter

Carefully read the denial letter to understand why your claim was rejected. Look for any errors or misunderstandings regarding your medical information or the insurance policy’s criteria.

Gather Additional Documentation

Collect further medical evidence that supports the necessity of the surgery. This could include more detailed letters from your healthcare providers, new medical test results, and records of your ongoing health conditions.

Formal Appeal

Submit an official appeal to your insurance company. This typically involves filling out an appeal form provided by your insurer and attaching all relevant documentation to strengthen your case. Be sure to adhere to any deadlines and procedural requirements specified by your insurance plan.

Be Proactive and Organized

By taking these steps, you increase your chances of having your appeal accepted and become more informed about your insurance plan and its processes. It’s essential to be proactive, organized, and persistent when appealing a denial, as this can significantly affect whether you receive the treatment you need.

Insurance Coverage Alternatives

If your appeal is denied, don’t lose hope. We offer several financing options to help you meet your goal. You can find financing plans through Kemba Financial Credit Union, CareCredit, and Prosper Healthcare Lending. Flexible savings accounts (FSAs) and health savings accounts (HSAs) also can be used to pay for a portion of your surgery.

Trust JourneyLite With Your Weight Loss Surgery

Ready to transform your life and health with weight loss surgery? Contact JourneyLite! Our team of dedicated professionals is here to guide you through every step of the process, from understanding your insurance coverage options to preparing for surgery. We believe in personalized care tailored to your specific needs and goals. Schedule a consultation today to learn what JourneyLite can do for you.

Request an appointment!

Frequently Asked Questions About Weight Loss Surgery

As a leading weight loss surgery provider, JourneyLite has a wealth of knowledge to share. Read the following question for the answers you’ve been looking for.

How Do People Afford Weight Loss Surgery?

Many insurance companies cover weight loss surgery under specific circumstances. If your plan doesn’t cover your procedure, we offer several financing options to help you afford it.

What Types of Weight Loss Surgery Are Typically Covered by Insurance?

Insurance typically covers surgeries deemed medically necessary, such as lap band and gastric bypass or sleeve procedures. Coverage can vary by provider, so it’s essential to check with your insurance company for specifics.

How Do I Know if My Insurance Covers Weight Loss Surgery?

To determine if your plan covers weight loss surgery, review your insurance policy’s benefits booklet or contact your insurance provider directly. You can also speak with one of our knowledgeable representatives, who can help clarify coverage details.