Weight Management Program

Insurance Reimbursement

Medical insurance covers part of the treatment of medical problems. Coverage for psychological or behavioral health may also be covered by medical insurance, but often under different rules (for example: prior approval, yearly expenditures, etc.). However, it is a patient's insurance company that determines what it will cover and how much it will cover. The Miriam Hospital does not control the insurance companies and only has control over the charges it sets for services.

Blue Cross
The Behavioral Medicine Clinic is a participating provider with Blue Cross Blue Shield of Rhode Island and Blue Chip. As a participating provider, we have agreed to accept assignment. There is a co-payment amount that is always the patient's responsibility. We bill Blue Cross for the medical visits to the Weight Management Program only. All other expenses associated with the program are out-of-pocket expenses. Co-payments for the medical visits are due at the time of service.

United Healthcare
The Behavioral Medicine Clinic is not a participating provider with United Healthcare for its weight management services. However, State United Health will cover the medical portion of the program. There is a co-payment amount that is always the patient's responsibility. We bill United Health for the medical visits to the weight management program only for those patients who are covered by State United Health. All other expenses associated with the program are out-of-pocket expenses. Co-payments for the medical visits are due at the time of service.

Neighborhood Health Plans of Rhode Island (NHP)
NHP covers the weight management program in its entirety. Details of the referral and authorization process for the program will be explained at the weight management orientation.

Again, you have Medical Insurance to pay for medical treatment of medical problems. Examples of medical problems are Hypertension, Diabetes, Cholesterol abnormalities, Coronary Artery Disease. The definition of medical is defined by the insurer. Insurers do not usually consider stress or obesity as medical problems, for example, nor do they consider stress management, weight loss, relaxation training, exercise, nutritional supplements, for example as medical treatments. While in some cases a program may not be covered, there may be certain parts of treatment that will be covered.

The Miriam Hospital, under no circumstances, can guarantee insurance coverage. For most patients, we will attempt to determine what extent your insurance will cover a program prior to your participation. For these patients that was to try to get direct reimbursement from their insurance company, we are happy to supply receipts, etc. to facilitate reimbursement.We cannot guarantee that any insurance coverage that may be active at the outset of a program will remain active throughout the duration of the entire program.

For complete details about our fees, or your health plan's policies, call and register for our next free orientation at 401-444-4800.

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