The Nicholson Clinic accepts and files most major insurance plans. Our team of insurance specialists are here to help you easily manage the process, working directly with your insurance provider to acquire approval. We are YOUR Insurance Advocates.
We are not contracted with Medicare, Medicare Replacement Plans, Medicaid, Tricare or Champus, and therefore cannot accept those insurance plans.
In many cases, bariatric surgery is considered a medical necessity and is at least partially covered by most insurance companies, provided the patient meets their requirements.
In our experience, the qualifying requirements are often:
- 35 BMI with underlying health conditions or
- 40+ BMI without diagnosed underlying health conditions
Coverage for your weight loss surgery is dependent on your specific insurance plan, however our insurance specialist will work with you and your insurance provider to help you minimize your out of pocket expense and maximize coverage for your procedure.
As with other healthcare procedures, patients are responsible for deductibles and co-pays. These out of pocket costs are required by your insurance company, not by Nicholson Clinic.
All procedures done by any other entity than Nicholson Clinic will be billed separately to your insurance company. You or your insurance company may incur additional charges for any of these services: blood work/ labs, pathology, dietician visits, psychology visits, anesthesia, prescriptions from a pharmacy, DVT sleeves, meal replacements / nutritional supplements.
Many insurance companies have an average four month process of criteria you need to complete before being approved for surgery. All appointments can be done via Telemedicine and there is no need to miss work!
INSURANCE CRITERIA – 6 TYPICAL STEPS
Everything can be done at YOUR convenience from the comfort of your home or office! No need to miss work!
- Body mass index (BMI) requirements to be confirmed by your physician. BMI over 40 OR BMI over 35 with one or more of the following:
- Clinically significant obstructive sleep apnea
- Coronary heart disease
- Medically refractory hypertension
- Type 2 diabetes
- Complete a medically supervised diet program.
- Schedule a psychiatric evaluation to obtain a mental health clearance letter. This can be done via Telemedicine.
- Schedule a nutritional evaluation from a Registered Dietitian. This can be done via Telemedicine.
- Send all of the above documentation to your insurance company along with a detailed history of your obesity-related health problems, difficulties and treatment attempts.
- Insurance company sends approval or denial letter.