Ambetter of Florida is an affordable healthcare option for open market insurance coverage. As an HCA Hospital affiliate, MASJax is the only surgical program in Jacksonville, Florida where Ambetter will offer coverage. Ambetter offers its members a range of plans for which MASJax providers are in-network. We are happy to discuss your benefits and coverage for your surgery and help walk you through what is required for coverage through your Ambetter Insurance plan.
The first thing to consider when reviewing your Florida Ambetter policy for surgery is what is covered and any exclusions, or non-covered services, in your policy. A phone call to your Ambetter service team can help you better understand your coverage and benefits. Should your surgery be excluded from your plan, as bariatric surgery is, you will typically see this indicated in the policy exclusions section of your insurance policy description. If your specific surgery is covered, your policy should have detailed information on the guidelines for qualification or pre-approval. We emphasize that coverage varies from plan to plan, and you should verify details directly with your insurance representative. Contact Ambetter as well as our office to discuss your eligibility and benefits early in your procedure.
The amount you will pay out of pocket for your surgical procedure will vary based on your benefits. Calling Ambetter to discuss your coverage and benefits using the phone number on the back of your card will allow you to better understand your policy. At your first appointment with us, we will discuss your benefits and financial responsibility. We will also review what your policy guidelines include for coverage and if pre-approval is necessary.
If your plan has a deductible, co-insurance, or an out-of-pocket maximum, we will review those amounts with you and break down how that translates to your surgery. For most plans, these amounts will reset each calendar year and any amount paid for services during the previous year will not be counted toward your maximum. With that in mind, if you have several claims earlier in the year, you may have met or be closer to meeting your plan’s out-of-pocket maximum.
Florida Ambetter does not cover bariatric procedures. These include the gastric sleeve (sleeve gastrectomy), the gastric bypass, and the duodenal switch. Despite evidence that bariatric surgery is a safe and effective treatment for obesity and its associated diseases, some insurances simply do not provide coverage. To provide care for those without coverage, MASJax offers a competitive self-pay bariatric program. We also work with third party financing providers for those without bariatric coverage or with high deductible plans. Please contact our team to discuss your options and how you can make weight loss surgery a reality.
Ambetter of Florida can be contacted via email or telephone. The best phone number to reach a representative for assistance should be listed on your insurance card. For other contact options: https://ambetter.sunshinehealth.com/