OCC Behavioral Charges Fact Sheet

Patients Applying for Gastric ByPass or Lap-Band Surgery

Program Fee: There is an initial program fee of $400 (required) which covers the Fitness Lecture Series. This is a mandatory fee. Our fitness series, offered every Thursday evening, offers a unique opportunity to interact with an expert in exercise physiology and learn about weight control and fitness. Individual sessions may also be arranged. We strongly urge all our surgical patients to attend as many of these sessions as possible.

Every third Thursday of the month, one of our surgeons is available to answer any surgical-related questions you may have. Again, this is a unique opportunity to interact with our surgeons in a smaller group setting.

Medical Visits and Surgery

Gastric Bypass Surgery: Almost all insurers cover the medical and surgical aspects of the Gastric ByPass. Before starting our program, always check with your insurer to see if these services are covered.

Lap-Band Surgery: As of January 2004, Tufts, Blue Cross and Harvard Pilgrim cover the "Lap-Band" surgery. Please check with your insurer to see if this surgery is a covered benefit under your plan.

Behavioral Visits Related to the Surgical Programs

Pre-op - Required: Each individual behavioral session (2-3 sessions): $50/session*
Pre-op - Required: Each weekly Behavior change Group session (6 sessions): $30/session*
Post-op - Optional: Each monthly support Group (12 sessions) $30/monthly session

Patients Applying for Physician-Supervised/Behavioral
Weight Loss Programs

All individual behavioral sessions $50/session*
Weekly weight loss group sessions: $30/session*

Patients Applying for Optifast Program

An initial $450 program fee, payable at the first visit, will cover the behavioral groups -- 12 weight loss support group sessions plus six transition phase sessions. If a full formula diet is used, the cost is approx. $400 per month for meals.

* Important Note: Most insurers do not cover our behavioral services. There are exceptions: Tufts (TAHP - co-pay on card, except Comm PPO - no benefits), Masshealth and Medicare - no copay, and possibly Blue Cross PPO. For these exceptions, a referral is required for all medical, behavioral and surgical visits. Also, see details in the following table.

	Behavioral Services: Initial Assessment	Behavioral Services: Basic Weight Loss Group	Behavioral Services: Post-Op Group	Medical Consultation and Follow-Up	Surgical Consultation and Follow-Up	Gastric Bypass Surgery	Laparoscopic Banding Surgery (LapBand)	OptiFast Liquid Diet
Tufts Affiliated Healthcare	Referral Required	Referral Required	Referral Required	Referral Required	Referral Required	Approval Required	Approval Required	Approx. $400 per month
MassHealth (Medicaid)	Referral Required	Referral Required	Referral Required	Referral Required	Referral Required	Approval Required	Not covered	Approx. $400 per month
Medicare	Referral Required	Referral Required	Referral Required	Referral Required	Referral Required	Approval Required	Not covered	Approx. $400 per month
Blue Cross PPO	Possibly covered: see below	Possibly covered: see below	Possibly covered: see below	Referral Required	Referral Required	Approval Required	Approval Required	Approx. $400 per month
Harvard Pilgrim Healthcare	Not Covered Fee: $50 per visit (2 visits required)	Not Covered Fee: $150 per 8-week group	Not covered Fee: $30 per monthly group	Referral Required	Referral Required	Approval Required	Approval Required	Approx. $400 per month
Fallon	Not Covered Fee: $50 per visit (2 visits required)	Not Covered Fee: $150 per 8-week group	Not covered Fee: $30 per monthly group	Referral Required	Referral Required	Approval Required	Not covered	Approx. $400 per month
Unicare	Not Covered Fee: $50 per visit (2 visits required)	Not Covered Fee: $150 per 8-week group	Not covered Fee: $30 per monthly group	Referral Required	Referral Required	ApprovalmRequired	Not covered	Approx. $400 per month
Aetna	Not Covered Fee: $50 per visit (2 visits required)	Not Covered Fee: $150 per 8-week group	Not covered Fee: $30 per monthly group	Referral Required	Referral Required	Approval Required	Not covered	Approx. $400 per month
Cigna	Not Covered Fee: $50 per visit (2 visits required)	Not Covered Fee: $150 per 8-week group	Not covered Fee: $30 per monthly group	Referral Required	Referral Required	Approval Required	Not covered	Approx. $400 per month
Blue Cross HMO	Not Covered Fee: $50 per visit (2 visits required)	Not Covered Fee: $150 per 8-week group	Not covered Fee: $30 per monthly group	Referral Required	Referral Required	Approval Required	Approval Required	Approx. $400 per month

Also See:

Fee Structure
Insurance Specifics
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