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Unfortunately, we can only accept Medi-Cal patients that live in Orange County. Please visit https://www.medi-cal.ca.gov/ to find a provider near you.

Will Your Insurance Pay for Weight Loss Surgery?

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First Name

Enter valid first name

Last Name

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HEIGHT

Feet

Inches

Enter Valid Height

WEIGHT

Lbs

Enter Valid Weight

Select procedure

Your body mass index (BMI) only qualifies you for the Gastric Balloon procedure. Please change your procedure selection to “Gastric Balloon” if you would like to proceed.Change to Gastric Balloon to proceed

Select Insurance Plan Type

Are you listed as the the Primary Subscriber on your insurance card?

Yes No Select any one option.

First and Last Name of the Primary Subscriber

Enter the Full Name of the Primary Subscriber

Full Name of your Primary Care Physician

Enter the Name of your Primary Care Physician

Select any one option.

Enter Your Insurance ID

Select Insurance Company

Select any one option.

Enter insurance company name

Select HMO Medical Group

Enter Provider Services Phone Number

If for some reason your insurance does NOT cover the procedure, how would you like to pay?

Select plan to pay for the procedure

Select credit score

Date of Birth (MM/DD/YYYY)

Invalid Date of Birth (MM/DD/YYYY)

Have you had weight loss surgery before?

Yes No Select any one option.

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Cell Phone (for text messages)

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