Forms
Please read the HIPAA form, then print and fill out the other two forms, and bring them with you to your FREE consultation.
READ:
HIPAA (Health Insurance Portability and Accountability Act)
PRINT AND FILL OUT:
Medical History Form
Patient Registration Form
Insurance Information
We will bill primary insurance for patients whose insurance covers weight management. As of January 1, 2010, ASEA / Local 52, IBEW, Aetna, Premera, United Healthcare,
Principle Life, and several others HAVE provided coverage. Not all employers who provide insurance include obesity as a covered diagnosis. Insurance quotes are not a
guarantee of coverage. Coded receipts are provided for insurance reimbursement if you wish to bill your insurance yourself.
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Frequently Asked Questions
How much do the programs cost?
The programs' costs vary depending on upon which program is selected. Start prices vary from $550 to $800. Follow up visits range from $98 to $205. Meal replacements and
medications are additional.
Will my insurance cover the program?
Insurance coverage varies. Some companies provide close to 100% of coverage whereas others completely exclude obesity treatment. It is best to review your policy holder's
manual.
Which insurance plans are currently providing coverage?
This question is a moving target! It really depends on where you work and what benefit components are included in the coverage purchased. As of January 1, 2010, the
following companies have shown some degree of coverage: ASEA - Local 52, IBEW, NEA, Premera (select groups), Aetna (select groups), Principal, and
Blue Cross. It is important to note that benefit quotes are NOT a guarantee of coverage!
Will you file my insurance for me?
If it has been confirmed that your insurance provides coverage for our services, we will file your insurance claim. You are responsible for any deductibles, copays and amounts not covered by your policy.
I only need to lose 20 lbs. Can I still be on one of your programs?
You must have a BMI (Body Mass Index) of 27 or higher to be an appropriate candidate for one of our programs. To calculate your BMI, go to the Resources page of our
website where you can find a BMI chart. Please call our office for more detatils.
I am a diabetic and have high blood pressure. Can I be on one of your programs?
We often work with Type II diabetics and patients who are hypertensive. Please call our office for more details.
How fast will I lose my excess weight?
Rate of weight loss is dependent upon your metabolic rate, caloric intake and energy output. How fast you will lose weight can be impacted by which weight loss program you
are on (i.e. OPTIFAST© vs. Calorie Counting). Your close adherence to the individualized program you develop with the provider is a key factor.
Do you have a maintenance program?
All our programs are focused on long term weight loss management. Close monitoring and ongoing guidance and support prepare each patient for a lifetime of weight maintenance.
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