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Why Add Insurance Information?

Optionally adding your insurance information will help expedite your check in process when you arrive for your scheduled consultation.

Insurance Information

Your insurance provider requires the following information for verification purposes. Please fill out the following form with the Primary Insurance Card Holder Information:

What is your relationship to the primary insurance card holder?
Primary Card Holder's First Name
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Primary Card Holder's Last Name
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Date of Birth
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NOTE: My Bariatric Solutions cannot accept coverage under Medicaid.

Insurance Provider

Primary Card Holder's Employer
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Insurance Subscriber/Member ID
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Insurance Group/Account Number
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Insurance Provider Phone Number
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Health Information

Please answer the following questions about YOU and your HEALTH.

Height (ft. in.)
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Weight (lbs.)
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Do you have any of these health issues?









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Our insurance specialists will review your insurance information and attempt to verify your bariatric weight-loss surgery coverage. This process may take several days and require additional information from you. Our goal is to get your insurance information answered within 7 working days.