There are several well-studied, long-term treatment protocols for addressing excess weight. Although they aren’t as “sexy” as the short-term fixes you see advertised everywhere, for most participants, they do result in sustained, healthy weight loss. Everything we do at Heartland Weight Loss is based on these types of interventions. These protocols involve frequent interventions with trained practitioners. In fact, the most well-studied program (the Diabetes Prevention Program or DPP) includes at least sixteen sessions in the first 6 months, followed by a minimum of monthly sessions thereafter. It’s a lot!
There are many factors that contribute to excess weight that we cannot change. However, the amount of time and energy that you invest in the process is something you can control. Although we would love to replicate the DPP and require all of our patients to complete 2-3 visits every month to optimize results, we do not require it. It’s your journey and we will respect that.
Obesity is a chronic, relapsing, multifactorial disease. Just like other chronic diseases, we believe the treatment of obesity should be covered under the umbrella of the traditional healthcare system. However, not all insurance carriers feel this way. They are allowed to exclude certain things, such as some or all treatments for obesity, including medical services, medications, and/or surgery. Health insurance represents a contract between you and your insurance company. Understanding what your insurance plan will and will not cover is your responsibility. These contracts specify several things that you need to be aware of:
- What type of services are covered by the contract (and which are excluded)
- Which providers are considered to be in-network. (Being in-network means that the insurance company and the providers have agreed to a predetermined fee schedule for services. This protects you and your insurance company from being obligated to pay outlandish fees for in-network providers, but it doesn’t guarantee that the insurance company will pay the fees. That falls under #3.)
- What portion of the services that each of you is obligated to pay (deductibles, copays, coinsurance, etc).
If you choose to utilize health insurance:
Office visits with Obesity Medicine specialists are billed using traditional medical office visit CPT codes. These vary based on the complexity of the medical decision-making required during the visit, and/or the time spent performing and charting the visit. We cannot tell you in advance what CPT code we will be using as we don’t know how much medical decision-making will be done and/or how much time it will take, but the vast majority of our visits and their associated charges are:
- 99204 (new patient, moderate complexity): $247.97
- 99214 (established patient, moderate complexity): $161.67
Occasionally, visits are more or less complicated or take minimal to additional time and are billed differently:
- 99205 (new patient, high complexity): $312.27
- 99213: (established patient, minimal complexity): $109.47
- 99215: (established patient, high complexity): 225.00
When visits are billed to insurance companies, we are required to attach diagnosis codes to the visit. These must reflect the diagnoses relevant to the visit. If we are actively managing diabetes, we can use a diagnosis code for diabetes. If we are addressing obstructive sleep apnea, we can use a code for obstructive sleep apnea. If we are only addressing weight, the only code that will be applicable to your visit is a code for overweight/obesity/severe obesity – whichever is applicable. We cannot tell you in advance what codes we will use to bill your visit as we don’t know what is going to be addressed until the visit occurs. *If we bill these charges to your insurance company and they consider it a non-covered service, you will be financially responsible for the full amount billed. You may switch to self-pay at the subsequent visit, but we will not adjust the fee retroactively.
Working within the limitations imposed by health insurance companies, it is nearly impossible to replicate the frequency of interventions studied in the Diabetes Prevention Program. Health insurance does not currently reimburse health coaches or nutritionists, so visits for patients utilizing health insurance at Heartland Weight Loss are limited to Obesity Medicine specialists (doctors and/or nurse practitioners).
If you choose to work outside of health insurance (self-pay):
NEW PATIENTS: begin with our Welcome Appointment consisting of an in-depth, new patient appointment with an Obesity Medicine specialist (regardless of complexity), a appointment with a nutrition coach, and a body composition analysis: $225
Once you have completed your new patient appointment, you will choose one of the following monthly packages to maximize support and outcomes:
Essential Care: $125/month: includes a monthly office visit with an Obesity Medicine specialist and a monthly body composition analysis.
Comprehensive Care: $200/month: includes everything in the essential care bundle PLUS a monthly visit with a nutrition/health coach, access to bi-weekly webinars, and access to the HWL exclusive app.
Ultimate Care: $325/mo: includes everything in the comprehensive ongoing care bundle PLUS an additional monthly visit with an Obesity Medicine Specialist or coach.
** Self-pay patients will be required to keep a credit card on file and monthly packages will process automatically on the first day of every month. Services purchased as part of a package must be redeemed within the calendar month and cannot be carried over to subsequent months. If you choose to cancel your recurring charge, you must notify us in writing (by email or via the patient portal) at least 48 hours prior to the first day of the month.
** A 5% discount will be given to patients that choose to purchase six months of any package upfront. If a refund is requested prior to the end of 6 months for any reason, a $150 early-termination fee will be deducted from the refund.
Important Information for ALL PATIENTS:
** If we are utilizing one or more anti-obesity medications, we require monthly office visits and monthly body composition analyses. We do not fill prescriptions for patients that are not being seen regularly.
** We require a $50 non-refundable deposit to hold all new appointment appointments. At the time of the visit, this will be applied to any balance due.
** Appointments that are missed and any appointment that is canceled/rescheduled less than 48 hours prior will result in a $50 fee. This cannot be deducted from future scheduled payments and must be paid prior to scheduling future appointments.
** Appointment times are limited to availability. Although we will make all attempts to reschedule appointments in the same month they were originally scheduled, we cannot guarantee future appointment times will be available.
** Lab tests and prescription drug coverage are completely separate from coverage for medical office visits. Regardless of whether our medical office visits are covered, most people with health insurance have some benefits for these services and we will always do our best to work within the existing system. When applicable, we send prescriptions to the pharmacy of your choice. When applicable, we provide lab orders with appropriate codes so that you can get labwork done at any lab that is in-network for you.
** FSA and HSA plans have a variety of rules regarding how they function. It is up to you to understand the nuances of your own FSA/HSA plan, including what services they will reimburse you for and what documentation they require for reimbursement. Although we are happy to provide you with a receipt listing services provided, we cannot guarantee reimbursement and we do not submit claims directly to FSA/HSA plans the same way we submit them to traditional insurance companies.