Does texas medicaid cover bariatric surgery

BENJAMIN CLAPP MD FACS

At El Paso Bariatric Surgery, we accept the insurance plans listed below. Feel free to call us at 915-351-6020 if you have any questions.

• AETNA
• ALLEGIAN
• Ambetter
• AMERIGROUP TX STAR PLUS
• BCBS TX ( Blue Choice PPO, HMO Blue Texas, Blue Advantage HMO, Blue Cross Advantage HMO and/or HMO Medicaid Managed Care Programs Networks)
• Care Improvement Plus
• CIGNA/GREAT WEST/PPO, OPEN ACCESS
• Cigna/ Healthspring
• CHOICE CARE/ HUMANA (products include: Humana PPO, HumanaHMO, Choice care PPO, Humana Gold choice PFFS and all other Humana Medicare Advantage)
• Coventry/FIRST HEALTH PPO
• El PASO FIRST
• EPMN
• GALAXY
• HEALTHSCOPE/ADVANTAGE CARE
• HEALTH SMART - Preferred Care Acccel/GEPO, Preferred Care PPO
• IMS PPO
• MEDICARE
• MCRG/ASSURED BENEFITS
• MOLINA TX STAR PLUS
• MOLINA TX MARKETPLACE
• MULTIPLAN/PHCS PPO, PHCS Savility
• STRATOSE PPO
• OPTUM/UNITED
• RR Medicare
• SUPERIOR-CHIP, Foster Care, Perinate, Star, Star-Kids, Star-Plus
• THREE RIVERS PROV NETWORK PPO
• TMHP (MEDICAID)
• TRIWEST, VAPC3, VA
• USA MANAGED CARE PPO
• Wellcare
• Wellmed

NEW MEXICO INSURANCE

• ACS/MEDICAID
• BC/BS NM
• Molina NM
• New Mexico Health Connections
• Presbyterian

EPMN (El Paso Medical Network)

Physician MCO Participation

• AMERIGROUP MEDICARE ADVANTAGE MEDICARE
• AMERIGROUP MMP
• AMERIGROUP STAR-PLUS
• COVENTRY/FIRST HEALTH AUTO
• COVENTRY/FIRST HEALTH PPO
• GALAXY HEALTH NETWORK PPO
• HEALTHCARE HIGHWAYS PPO
• HEALTHSMART PREF CARE ACCEL/GEPO
• HEALTHSMART PREF CARE PPO
• HUMANA MEDICARE
• HUMANA NNA HMOx/EPOx
• HUMANA PPO
• IMS PPO
• MOLINA HEALTHCARE TEXAS CHIP
• MOLINA HEALTHCARE TEXAS EXCHANGE
• MOLINA HEALTHCARE TEXAS MA
• MOLINA HEALTHCARE TEXAS MMP
• MOLINA HEALTHCARE TEXAS PERINATE
• MOLINA HEALTHCARE TEXAS STAR
• MOLINA HEALTHCARE TEXAS STAR-PLUS
• MULTIPLAN/PHCS PPO
• MULTIPLAN/PHCS SAVILITY
• STRATOSE PPO
• SUPERIOR HEALTH PLAN - AMBETTER
• SUPERIOR HEALTH PLAN CHIP
• SUPERIOR HEALTH PLAN FOSTER CARE
• SUPERIOR HEALTH PLAN PERINATE
• SUPERIOR HEALTH PLAN STAR
• SUPERIOR HEALTH PLAN STAR-KIDS
• SUPERIOR HEALTH PLAN STAR-PLUS
• THREE RIVERS PPO
• TRIWEST, VAPC2, VA
• USA MCO PPO
• WELLCARE MEDICARE

We are happy to say that there is insurance for Bariatric Surgery that covers more than 80% of our bariatric surgeries and Texas Bariatric Specialists (TBS) accepts all major insurance plans, including Medicare!  The only insurance we do not accept at this time is Medicaid.  A few major insurances accepted at TBS are, but not limited to are:

Bariatric procedures are covered by most insurance companies as long as you meet their requirements and as long as your employer chooses weight loss surgery as part of your benefits package.

The good news is that we are the experts when it comes to insurance and bariatric coverage.  We make your life easier every step of the way through your insurance requirements.

Insurance Requirements

Most insurance companies have similar criteria when approving a patient for bariatric surgery.  Here are the most common requirements:

• Have a BMI (body mass index) of at least 40, or a BMI of 35 and above with one or more obesity related comorbid condition (calculate your BMI).
• A psychological evaluation.
• A dietary evaluation.
• A monthly diet, typically 3 to 6 months.
• Some insurances require a referral from your primary care physician.
• A weight history from your primary care physician proving you have been overweight for an extended period of time.
• A letter of medical necessity from your primary care provider.

Some insurance companies require only the top three requirements while others require all seven.  Because every insurance is different, we provide every patient with an insurance advocate to help you understand your individual insurance requirements and facilitate your weight loss journey.

Tools Provided to Complete Your Insurance Requirements

• A unique concierge service to help you complete your surgeon visit, dietary, and psych evaluations all on the same day and in the same office as your seminar.
• An insurance advocate that will help you understand your personal requirements and help you with all of your questions and concerns throughout your weight loss journey.
• Some of our locations are open on Saturdays to work around your schedule.
• A login for our patient portal to track your progress and see what else you’re required to complete before surgery.
• Nine clinic locations across South Texas for appointments and fully stocked with bariatric protein and vitamins.
• Support Group meetings once a month and an online Support Group if you prefer to stay home. Pre-operative patients are urged to check out one of our support groups to ask questions and learn about life post-operative from former weight loss surgery patients.
• If you have a smartphone, we have a free app available in the iTunes and Google Play store.  Click here for more information about our Smartphone App here.

Even with insurance “hoops,” at Texas Bariatric Specialists, we strive to make your entire experience effortless.  TBS will be with you every step of the way so you will never feel alone or lost in your journey.