Dear Prospective Patient,
Thank you for inquiring about weight loss surgery. Since 1979 we have specialized in performing a
well-known and very successful surgical weight loss procedure called Roux-en-Y Gastric Bypass. We
also perform the Gastric Banding, Gastric Sleeve, and Duodenal Switch procedures. Over the years
our patient base has grown to over 18,500 patient surgeries. We are happy to have one of the largest
and most successful bariatric practices in the country.
Enclosed you will find details about weight loss surgery, biographies of each of our surgeons and
information regarding the process of obtaining weight loss surgery from Rocky Mountain Associated
Physicians (RMAP). It is very important that you sit down and read the information in its
entirety to help us provide you with the best service possible.
Whether you are self paying for your surgery, or seeking authorization from your insurance company,
please follow the detailed instructions. This will show you all the information you need to gather. We
will not be able to proceed with your request for weight loss surgery without all required information. If
your paperwork is incomplete it will be sent back to you for completion.
Our office will communicate with you through e-mail, as this has proved to be the most efficient way
to update one another. If you have not provided us with an e-mail address, we will send you the initial
correspondence through regular mail.
If you have any questions, please contact us at 1-800-999-9970 or 801-268-3800 or email us at
info@rmapinc.com.
Sincerely,
Rocky Mountain Associated Physicians Team
1160 East 3900 South, Suite 4100
Salt Lake City, Utah 84124 / Toll-Free 800-999-9970 Phone 801-268-3800 / Fax 801-268-3997
Rocky Mountain Associated Physicians
The Patient Steps to Weight Loss Surgery
For Insurance Patients
You will need to follow the steps below to obtain weight loss surgery from our office: 1. Attend “The Risks and Benefits of Weight Loss Surgery” Class (Required Class)
You may have already attended this class. Here, you will receive an information packet, as well as specifics regarding all four surgical procedures. Part of this class is taught by one of our surgeons. It is required for all patients who live inside a 200 mile radius of Salt Lake City. (1 to 2 hour meeting). For those living outside of that radius, we offer this class ‘live’ online twice a month.
2. Turn in your completed packet, along with a copy of the front and back of your insurance card, to our office. Make sure that you select a Surgeon as well as the procedure that you are most interested in.
3. We will then send you emails within a day or two from our office, (if an email address is not provided, this information will be mailed to your home address.
a. The first will inform you that we have received your packet, and have begun the process of checking into your insurance.
b. The second will let you know if your insurance coverage has weight loss surgery benefits. If so, this email will also include their requirements which you will need to complete prior to obtaining an approval for your surgery. If your insurance coverage does not include weight loss surgery, this email will inform you of our Private Paying options that we offer.
4. Start working on the insurance requirements that we informed you of. ALL insurance policies are different and have unique requirements. The above email will give you contacts of providers that we work with if needed. As soon as you have the documents of the completed requirements, send them to our office, attention Christina.
5. When we have received all of the documentation for the required tasks, we will call you to schedule your Physician Consultation - Informed Consent and Awareness Class. Here you will be taught more about your surgery, as well as undergo an examination to ensure that you are ready for surgery. Please plan the entire morning or afternoon. You may be in our office 3 to 4 hours. Due to the length of time, we ask that you please do not bring your children.
6. The ‘Consultation’ is the last requirement from your insurance company. We will then include the Physician notes with your packet and send it to your insurance company for a prior authorization approval request. (The average response time is 1-2 weeks to hear back from them. They have up to 30 days to respond).
7. Once approved, we will notify you by phone and schedule your surgery. Cathy, the surgery Coordinator at RMAP, will call you to schedule your surgery date, as well as the “Surgery Orientation Class”.
Please note: Once your surgery is scheduled you may not change the date! Only your surgeon
may change the date. There are too many complicating factors associated with changing the schedule for Weight Loss Surgery with the hospital, surgeon and insurance. Please do not expect your date to be changed for any reason once you are scheduled.
8. Attend Surgery Orientation Class at RMAP (Required Class). Provide Payment.
Here, you will learn what is necessary for your surgery…”The Do’s and Don’ts”. You will also hear from a Registered Dietician to discuss dietary guidelines. Your Education Materials will be given to you. We’ll also take a “Before” picture for you to place in your booklet. Deposits are due at this time as well. (2 ½ hour meeting)
Insurance Patients 100% Coverage 90% 80% 70% 60% 50% Medicare Surgeon Deposit 0 $500 $1000 $1500 $2000 $2500 $420 Assistant Surgeon Deposit 0 $100 $200 $300 $400 $500 $ 64 Education Program $500 $500 $500 $500 $500 $500 $500 Total Deposit $500 $1100 $1700 $2,300 $2900 $3500 $984
Make Payable to Rocky Mountain Associated Physicians. (Major Credit Cards are accepted, along with cashier checks, or money orders. No personal checks please).
* If your insurance covers 50% or less please contact the hospital to get an estimate of what your hospital charges will be. All hospital charges vary.
9. Have your surgery.
10. Attend an “Emotional Support” class held two to four weeks after your surgery.
This class is taught by a LCSW and weight loss surgery patient as well. Here you will learn important keys in successfully managing the emotional side of eating and comfort.
Additional Billing and Payment Information
- PLEASE READ CAREFULLY -
Office Visits Gastric Bypass, Sleeve and D. Switch- For self-paying patients the initial office visit consultation is a $200 deposit which is applied toward the surgery fee. If you have your consultation with the physician(s) and decide not to have surgery the $200 will be used to cover the office consultation visit. After your surgery you will receive 1 year of office follow-up visits at no charge.
Office Visits Lap Band- For self-paying patients the initial office visit consultation is a $200 deposit which is applied toward the surgery fee. If you have your consultation with the physician(s) and decide not to have surgery the $200 will be used to cover the office consultation visit. Band adjustments are included as part of surgery for the first 12 months. Following the first year, Band adjustments will incur a charge of $100 in the office and $225 if the adjustment requires radiology services at the hospital.
For Patients Covered by Insurance – Routine follow up visits for insurance patients will be at no charge for the first 90 days depending on provider contracts with insurance. After 90 days the office visit co-pay will be due at the time of service. Should a Lap Band Adjustment be needed, insurance authorization is necessary prior to the adjustment. Lap Band adjustment charges may be processed to your deductible. Regular Co-Pay charges will be due at the time of the visit.
Any additional procedures associated with the follow up office visit will incur a charge (i.e. B12 injections etc.). Additional office services are not part of the “no” charge policy for self-pay patients.
You are financially responsible for all charges whether or not your insurance company pays. If you have any billing questions, please contact your surgeon’s office.
Please Note: For cash pay patients, if the insurance pays for your office visit(s) RMAP will accept that money as payment for the office visit and is not refundable.
Medicare / Medicaid Patients: We are not providers of Medicaid for patients who live outside of Utah. Returned Checks will incur a $20.00 service charge.
Rocky Mountain Associated Physicians
RMAP
The Patient Steps to Weight Loss Surgery
Self-Pay Patients
If you do not have insurance that covers weight loss surgery, here are the steps for you to complete: 1. Attend “The Risks and Benefits of Weight Loss Surgery” Class (Required Class)
This class is required for those who live inside a 200 miles radius of Salt Lake City. You may have already attended this class. You will receive an information packet at this meeting. Patients living outside a 200 miles radius of Salt Lake City have received the necessary paperwork and information contained in this packet by mail. (1 to 2 hour meeting)
2. Fill out and turn in your paperwork to Rocky Mountain Associated Physicians Office
Include with your paperwork all the necessary information listed on the “Self Pay Patient Check List”, which is at the bottom of this page. If you need additional assistance, please call RMAP to make an appointment with Christina, your Patient Advocate, who will review your paperwork and answer your questions. *Once your paperwork is submitted, the doctor will review it and we will be in contact with you to schedule your consultation.
3. Physician Consultation and Informed Consent Class (Required Class)
We will contact you to schedule your consultation, as well as schedule you for the Informed Consent and Awareness class. This class will be the same day as your consultation with your surgeon. A $200 payment is due for your Physician Consultation at the time of service. If you proceed with surgery the $200 will be applied toward your surgery deposits.
Please plan the entire morning or afternoon for the class and consultation. Immediately following the class, your surgeon will meet with the class as a group, and then individually. You may be in our office 3 to 4 hours. Due to the length of time, we ask that you please do not bring your children.
* All patients wanting Gastric Banding surgery must attend this consultation, regardless of where you live.
4. Attend Surgery Orientation and Education Class at RMAP (Required Class). Provide Payment. Here, you will learn what is necessary for your surgery…”The Do’s and Don’ts”. You will also hear from a Registered Dietician and Social Worker to discuss dietary and emotional guidelines. Your education materials will be given to you. We’ll also take a “Before” picture that will be ready for you at your first follow up appointment. The total cost of surgery is due at this appointment. (2 ½ hour meeting)
5. Attend an “Emotional Support” class held two to four weeks after your surgery. This class is taught by a LCSW and weight loss surgery patient as well. Here you will learn important keys in successfully managing the emotional side of eating and comfort.
SELF PAY PATIENT’S CHECK LIST
Completed
Completed RMAP Patient Information Form
Yes NoCompleted RMAP Medical History Form
Yes NoSelected your Surgeon and Procedure
Yes NoSelf Pay Costs
June 2015
Gastric Bypass 43644 Gastric Banding 43770 Gastric Sleeve 43775 Duodenal Switch 43845 Physician Consultation $200 $200 $200 $200 *Surgeon Fee (Less $200 Consultation) $ 5,765 $ 4,300 $4,300 $7,240 Anesthesiologist Fee $ 1,100 $ 880 $880 $1,100 Assistant Surgeon Fee $ 1,200 $ 900 $900 $1,500 Education Program(Required) $500 $500 $500 $500
Total to R.M.A.P. $8,765 $6,780 $6,780 $10,540
All above payments should be payable to “Rocky Mountain Associated Physicians”, when you attend the Surgery Orientation class at RMAP.
Hospital Fee Inpatient
St. Mark’s LDS $10,660 $10,600 $8,450 $8,545 $9,700 $10,275 $ 16,995
Outpatient (certain criteria applies)
$6,280
Inpatient fees payable to the hospital where your surgery is to be performed. Outpatient
Fees should be combined with surgeon fees and made payable to “Rocky Mountain Associated Physicians”.
Grand Total Fees St. Mark’s LDS St. Mark’s Outpatient $19,425 $19,365 $15,230 $15,325 $13,060 $16,480 $17,055 $27,535
All payments are required when you attend the Surgery Orientation Class! (Credit Cards Accepted)
All Payments are Required Prior to Surgery
All payments and deposits are due prior to surgery for surgeon’s office and Hospital.
Hospital and surgeons office requires all deposits in the form of a cashier’s check, money order or credit card. (No Personal Checks).
Pay the hospital fee to the hospital separately. Outpatient Surgical Center is paid to RMAP.
The surgeon retains $25.00 for the collection of Anesthesia and Outpatient Surgical Center fees for self pay patients. Please note: If surgery takes longer than normal you may be billed for additional Anesthesia time by the Anesthesiologist.
You might receive an invoice from Utah Imaging Pathology should they be required to assist with x-rays. They are not associated with the hospital, and bill separately. They offer our patients a discount, and charges are usually between $50 and $150.
The prices quoted above are for weight loss surgery only. Other services may be required that are not listed above i.e. radiology, pathology etc. Any other procedure i.e. gallbladder removal, hernia repair, etc., performed at the time of surgery will be billed as secondary procedures and there may be additional charges. Gastric Banding patients may receive additional charges from a radiologist for reading the barium swallow results associated with surgery.
- Charges can vary according to circumstances and are subject to change without notification.
Self Pay Patients
Complication Coverage – St. Mark’s Hospital
We are happy to announce that effective 4-1-2014; the hospital fee for the Gastric Bypass, Gastric
Band, Gastric Sleeve, and the Duodenal Switch
at St. Mark’s Hospital includes financially covering
most complications. This was done to give private paying patients peace of mind, minimizing the
financial worry should a complication arise. Here are the details:
Gastric Bypass
$10,660 Hospital Fee
Complications covered include: Cardiopulmonary events, Thromboembolic
events, Bleeding, Infection, Leaks, Perforations, Obstructions, and Stenosis.
Complications can occur anytime from the day of surgery through 90 days. The
cap amount is $100,000. Should they go over that amount, they pay 25% of
charges.
Gastric Band
$8,450 Hospital Fee
Complications covered include: Cardiopulmonary events, Thromboembolic
events, Bleeding, Infection, Leaks, Perforations, Obstructions, Band Erosion,
Band Slip, and Port Site Problems. Complications can occur anytime from the
day of surgery through 90 days. The cap amount is $30,000. Should they go
over that amount, they pay 25% of charges.
Sleeve Gastrectomy
$9,700 Hospital Fee
Complications covered include: Cardiopulmonary events, Thromboembolic
events, Bleeding, Infection, Leaks, Perforations, and Stenosis. Complications
can occur anytime from the day of surgery through 90 days. The cap amount is
$100,000. Should they go over that amount, they pay 25% of charges.
Duodenal Switch
$16,995 Hospital Fee
Complications covered include: Cardiopulmonary events, Thromboembolic
events, Bleeding, Post Operative Infection, Leaks, Perforations, and Stenosis.
Complications can occur anytime from the day of surgery through 90 days. The
cap amount is $100,000. Should they go over that amount, they pay 25% of
charges.
The fee stated above includes the coverage for complications. The fees mentioned above cover St.
Mark’s Hospital, Surgeon and Assistant Charges. These are the majority of financial charges for
complications.
It is important to note that this financial coverage does not include charges from
independent providers, even those who might treat you at St. Mark’s hospital.
Examples of Non Covered Charges would be:
E.R. Physicians - Anesthesiologists - Radiologists as well as specialist
fees, or any provider that bills outside of St. Mark’s Hospital.
LDS Hospital
Metabolic and Bariatric Surgery Self-Pay Patient Financial Agreement INSURANCE HAS DENIED COVERAGE FOR GASTRIC PROCEDURE:
____(Please initial here)
Your insurance has denied coverage for your gastric bypass procedure. You will be registered in our system as a self-pay patient. Your insurance will not be billed for any services provided in conjunction with the gastric bypass or lap banding procedures.
LAPAROSCOPIC GASTRIC BYPASS PROCEDURE: ____(Please initial here)
You are having a laparoscopic gastric bypass procedure. You have made a $10,600 deposit, and if there are no complications, your procedure will be considered paid in full. Complications are defined as any laparoscopic gastric bypass procedure with charges in excess of $100,000. If the charges exceed $100,000 (considered “complicated”) you will be responsible for 60% of the charges in excess of $100,000. Your initials indicate that you have been verbally counseled regarding the final charges for the laparoscopic gastric bypass procedure and understand that if necessary you are responsible to make financial arrangements with one of our Patient Account Services representatives upon receipt of your bill.
LAPAROSCOPIC SLEEVE GASTRECTOMY PROCEDURE: ____(Please initial here)
You are having a laparoscopic sleeve gastrectomy procedure. You have made a $10,275 deposit, and if there are no complications, your procedure will be considered paid in full. Complications are defined as any laparoscopic gastric bypass procedure with charges in excess of $100,000. If the charges exceed $100,000 (considered “complicated”) you will be responsible for 60% of the charges in excess of $100,000. Your initials indicate that you have been verbally counseled regarding the final charges for the laparoscopic gastric bypass procedure and understand that if necessary you are responsible to make financial arrangements with one of our Patient Account Services representatives upon receipt of your bill.
LAPAROSCOPIC GASTRIC LAP-BAND PROCEDURE: ____(Please initial here)
You are having a gastric lap-band procedure. You are making a $8,545.00 payment today and if there are no complications, your procedure will be considered paid in full. Complications are defined as any lap-band procedure with charges in excess of $100,000. If the charges exceed $100,000 considered “complicated”) you will be responsible for 60% of the charges in excess of $100,000. Your initials indicate that you have been verbally counseled regarding the final charges for the lap-band procedure and understand that if necessary you are responsible to make financial arrangements with one our Patient Account Services representatives upon receipt of your bill.
LAPAROSCOPIC GASTRIC LAP-BAND REMOVAL PROCEDURE:
____(Please initial here) You are having a gastric lap-band removal procedure. You are making a $2000.00 payment today and if there are no complications, your procedure will be considered paid in full. Complications are defined as any lap-band removal procedure with charges in excess of $100,000. If the charges exceed $100,000 considered “complicated”) you will be responsible for 60% of the charges in excess of $100,000. Your initials indicate that you have been verbally counseled regarding the final charges for the lap-band procedure and understand that if necessary you are responsible to make financial arrangements with one our Patient Account Services representatives upon receipt of your bill. If you receive additional hospital services following discharge from your gastric procedure, those services
Rocky Mountain Associated Physicians
Support Group
Support Groups are designed to bring patients together to support, share, and work together. We are
excited to offer the opportunity to help guide you on this exciting journey through weight-loss surgery
to a happy and healthier lifestyle.
Support Groups are held on varying Wednesdays from 6:30-8:00 pm in our Education Center, located
in Suite 4200 of the North Medical Building at St. Mark’s Hospital. All Support Groups are included in
your Education Program, paid with your bariatric program fee at the time of your surgery.
We would love to see every future and past patient taking advantage of the opportunity to share and
learn from each other. We hope you will join us.
Stage I - Early Weight Loss Group. This group includes patients who have had surgery but are less
than six months out from their surgery date. This group focuses intently on supporting and helping
new patients as they adjust to the many changes they face after surgery. Questions and concerns
about the early stage of weight loss will be answered. This group is held on the first & second
Wednesday of each month from 6:30 until 8:00 p.m.
Stage II - Weight Loss Group. This group is for patients who are six months out from their surgery
date and still in the weight loss phase. This group focuses on identifying habits, thinking errors,
self-defeating beliefs, and unresolved emotional issues which, if left untreated, are likely to sabotage the
patient’s long-term success. Patient’s are encouraged to meet their weight loss goal and carefully
directed in how to approach the maintenance phase successfully.
This group is held on the third Wednesday of each month from 6:30 until 8:00 p.m.
Stage III - Maintenance Group. This group includes patients who are finished with the weight loss
phase and are in the maintenance phase. This group focuses intently on helping patients adjust to
maintenance without excessive weight gain. Questions and concerns about the lifetime commitment
to weight loss maintenance are the focus.
RMAP Education Program $500-
(Not Covered by Insurance)
RMAP Education Binder ($150 to replace)
1. Pre Surgery Information
Pre Surgery Information Brochure and Patient Information Forms Risks and Benefits Printed Materials
Informed Consent Printed Materials Pre Surgery Orientation Printed Materials
2. Post-Surgery Information
Patient Guidelines Summary ($35 to Replace) Other Printed Educational Materials
Support Group
3. Miscellaneous Materials
Daily Food Journal Form Menu Planner Form
Grocery Shopping List Form
Weight and Measurement Tracking Form Vitamins List
BMI Chart
Internet Resources Information Post Op Log
Therapist List
Picture Booklet / Reminder Card Holder ($15 to replace)
Medical / Restaurant CardUse this at other physician offices or hospitals to show your anatomy and or procedure. It will be helpful for other physicians to understand your new gastric pouch while providing you with treatment.
Reminder Cards
These cards are designed to be quick references to help remind you of the types of food to eat hydration requirements etc. You may want to keep them with you in your planner or purse.
Picture and Video CD ($5 for replacement)
You will receive a CD with your before surgery photo. We encourage you to take pictures of your progress as reminders of the success you are having at different stages. We will take a picture at your one year visit and provide you with another CD at that time. The CD will also contain video you can watch on your computer of special Salt Lake Support Group presentations.
Education and Classes ($350)
1. The Risks and Benefits of Weight Loss Surgery Class 2. Informed Consent and Awareness Class
3. Pre Surgery Orientation Class
4. One year paid membership “Obesity Action Coalition”
5. Support Group Coordination and Presentations (Lifetime)
6. Group Therapy – Dealing with emotional challenges. (Nine sessions offered per year. Unlimited
participation).
7. RMAP Telephone Support from the Education Department (During Business Hours) 8. Internet Based Support which Includes:
*Patient Support Forums *Online Newsletters and Information *Electronic Communication with RMAP Office *Patient Chat Rooms *On line access to Patient Medical Record (Secure Access)