Patient resources
Insurance and referrals
Some plans require a referral from a primary care clinician before a surgical consultation, and many require a documented review before an operation is approved. This page explains the process. It does not list carriers, networks, coverage claims, or prices, because those change and a general statement would not be accurate for your specific plan.
Do you need a referral
That depends entirely on your plan, not on this practice. You can request a free “benefits check” through the secure benefits form. Plans that require a referral will say so on the member card or in the member portal. If you are unsure, call your insurance provider, ask your primary care office, or call our office for guidance.
If your plan does not require one, you can request a consultation directly.
What a “benefits check” involves
A “benefits check” confirms what your plan says about surgical care before anything is scheduled. It is a conversation between our team and your plan, and it happens before you are asked to make a decision.
Documentation plans commonly ask for
Coverage review for metabolic and reflux surgery is usually documentation driven. The specific list varies by plan.
- Clinical notes describing the condition and prior treatment.
- Results of relevant testing, such as endoscopy or pH monitoring for reflux.
- A record of nonsurgical treatment already tried.
- Nutrition and behavioral health evaluations for metabolic surgery, when the plan requires them.
If you are paying without insurance
Self-pay is an option, and not uncommon, for bariatric procedures, both surgical and endoscopic. There are multiple considerations that must be reviewed. These will be discussed with each individual patient by our team, specific to their situation.
Common questions
- Will you tell me whether my plan covers surgery?
- Yes, we will discuss this in detail with each patient individually. Coverage questions are answered by your plan for your specific policy. Our team helps gather and submit the documentation a prior authorization requires.
- Can I be seen while a referral is still pending?
- Sometimes. It depends on your individual insurance plan.
More patient resources
Next step
Send the details needed to begin a benefits review.
Start a benefits questionLast reviewed