Insurance and Finance

Part of maintaining our Bariatric Center of Excellence accreditation involves a process patient education. We have extended this process to help you better understand your insurance benefits. The SC Obesity Surgery Center is an affiliate of Lexington Medical Center. Through this partnership, we are able to evaluate costs on a regular basis. Therefore, we do not pass on any unnecessary charges to the patient. We are proud to be one of few bariatric programs in the state that does not have a program fee for our patients.

Contracts

The contract for your medical insurance plan has a set of defined benefits chosen by your employer. For any procedure, the out-of-pocket cost for each patient may differ based upon the specific terms of this contract. We participate in most major insurance plans including Medicare. If your policy has an exclusion for bariatric surgery or if we do not participate with your insurance carrier, we will inform you of this and review alternative payment options. Our goal at the SC Obesity Surgery Center is to make sure you have a pleasurable experience, throughout your journey, including understanding your financial responsibility.

Pre-determination

The SCOSC will coordinate eligibility pre-determination for our patients to include the following:

- Letter of Medical Necessity

- Psychological evaluation:

- Specialist evaluations:

The pre-determination process does not begin until we have received your clearance.

Co-Pays/Co-insurances

A co-pay or co-insurance will be due at the time of your initial consultation.

Self Pay or Non-covered Service

If you do not have medical insurance or if your policy has an exclusion for bariatric surgery you may consider paying for the procedure yourself. At your consultation you will meet our financial counselor and review the costs associated with your procedure and discuss finance options.

Insurance work sheet

We will provide you with the diagnosis code (ICD9) and surgical code (CPT) for each of the procedures along with a list of questions to ask your insurance carrier. This will assist you in making an education decision as to which procedure is best for you.

The SC Obesity Surgery Center & Lexington Medical Center have been designated as centers of excellence for the following insurance carriers:

Aetna Bariatric IOQ network

OptumHealth Care Solutions (formerly United Resource Networks)

Blue Distinction Centers for Bariatric Surgery Program (Blue Cross Blue Shield Association)