********Patients with Medicare as their primary insurance can no longer utlize our program.  Currently, Medicare has requested all patients utilize a recognized Center of Excellence through the American Society for Bariatric Surgery or the American College of Surgeons.  For a list of those centers, please visit www.asbs.org.*********

Slimlife Center accepts most insurance plans, including Blue Shield, Cigna, Aetna and United  Healthcare PPO Plans.  Some Blue Cross PPO plans can utilize our facility but others may not.  We accept most HMO's through  Mercy Medical Group, Hill Physicians Medical Group, Golden State Medical Group, and Sierra Nevada IPA.  If you have Health Net, please contact us directly to determine where you can have your surgery.  

MONEY MATTERS: 

All patients are responsible for meeting their plan deductibles, copays, and percentage of allowed expenses for services provided.

Out of Pocket Expenses:

The following out of pocket expenses apply to all patients, unless your insurance is an HMO through Mercy Medical Group, Hill Physicians Medical Group, Golden State Medical Group, or Sierra Nevada IPA.  For more information, contact (916) 423-2116.

Administrative and Program Fee:  $750.00   This is payable after your surgery has been approved and you have a surgery date.  Dr. Koura will see you for one last pre-op appointment prior to surgery and will accept your payment in full at that time.  Cash and checks are accepted.  Please note, we do not take MasterCard, Visa, or other credit cards.

PPO Insurance Copay: $500 UPFRONT FEE. This fee is due BEFORE surgery and will be applied to the "patient portion" of your bill with Dr. Koura.  If there is additional payment due after your surgery is billed to your insurance, Dr. Koura's office will send you a statement for the remainder of the balance.  If your portion is less than $500, Dr. Koura's office will issue a refund as soon as your insurance pays your balance and informs his office.  We regret that we have to implement this policy, however most patients with a PPO insurance have a copay or "patient portion" after insurance pays and the proper insurance adjustments have been taken.  Unfortunately, many patients are not paying their portion, leaving large unpaid balances with the surgeon.  To reduce this, we have implemented this policy which takes effect immediately.  

Psychological evaluation:  This fee is generally covered through your insurance plan, however if no benefit is available, the fee can vary from $100 - $300 and every patient is required to have this complete.

Medical Records:  Please keep in mind that some medical offices will charge  to copy your records.  If a patient seeks surgery and has an extensive medical history with significant health problems, or if you have an insurance company that requires five years of medical records for approval, your healthcare provider's office may charge you, the patient, to have your records copied.  We will do our best to request the minimum amount of records necessary, but these expenses are out of our control.

Getting Your Bariatric Surgery Covered:

Regarding insurance, the following steps may seem difficult and confusing, but please know that assistance is available.

Benefit Verification. Do you know if surgical treatment for morbid obesity is a covered benefit under your specific policy? Review your benefits brochure and look for any exclusions of this benefit. If no exclusion exists, a representative of the insurance company can be contacted to verify whether the benefit is actually available. Your insurance may give a yes or no answer, or they may withhold information until all documentation has been received and a pre-determination has been made about the necessity for you to have surgery.

Please note: "Obesity" and "morbid obesity" are defined as different health conditions. Some insurance plans will reject treatment for obesity but will cover treatment for morbid obesity. Be precise in the words you use when working with insurance companies. Check more than one source when verifying your insurance policy benefits for morbid obesity. Unfortunately, not all representatives are knowledgeable about their policies and may not know what morbid obesity is. This lack of knowledge may result in you receiving wrong information.

1. Medical records. Medical records must be submitted with all other documentation prior to the insurance company making a determination.
2. Documentation of Dieting and Exercise. Insurance companies may require your diet history showing that you have made repeated attempts at conventional weight loss, through diet and exercise. Some insurance companies require a six-month medically supervised program, which shows monthly weigh-ins, vital signs, nutritional counseling and an exercise program.
3. Psychological evaluation. To ensure that you are mentally stable to withstand surgery, a psychological evaluation is required and will be sent with your authorization paperwork to your insurance company for their review.
4. Letter from your bariatric surgeon. Your surgeon writes this letter summarizing your medical, diet, and exercise history and your present health status. The letter helps outline why surgical treatment for morbid obesity is medically necessary. This letter is submitted with all your other medical history and documentation and a pre-determination is requested that the insurance company will pay for the surgery.
5. Predetermination. Once all of the above is sent to the insurance company, they begin a review process of your information to determine if they will approve this benefit for you. They may ask for more documentation from you, or approve or deny this benefit from you. If you are denied, you can appeal the decision. Most insurance companies have three appeals that they allow you to make. Make sure all documentation is complete prior to filing an appeal. Some initial denial decisions are overturned in later appeals.