Bariatric surgery insurance approval does not come easy. There are many requirements to meet depending on your health insurance plan to prove that it is medically necessary. While most major insurance companies have some version of weight loss surgery coverage, it is important to check and see what your specific policy covers. It may only cover the procedure, but not the hospital stay or anesthesia. Start by contacting your insurance carrier and see what your policy entails exactly; you can usually find the number on the back of your insurance card. Your local bariatric specialist’s office staff can also check to see if you have coverage.
Following these eight steps is a good way to get your bariatric surgery insurance approval:
1) Confirm your minimum body mass index (BMI) requirements with your doctor.
- BMI above 40
- BMI above 35 with a health condition related to weight such as obstructive sleep apnea, heart disease, Type 2 diabetes, and difficult-to-treat high blood pressure.
Programs must range from 3 to 7 months, usually consecutively. Not only does it help the surgeon complete the operation with success if you’ve lost a few pounds, it reduces the chances of complications during the procedure. It also makes the post-op diet easier to follow if you start to break some bad habits beforehand.
3) Next, you should schedule a personal consultation with a bariatric surgeon.
They can discuss any medical questions or concerns in regards to the operation and which one is right for you. Here at Riverside Surgical & Weight Loss Center, you will have to attend one of our free monthly weight loss seminars held at Sebastian River Medical Center first before meeting with one of our surgeons. Or for your convenience, you have the option to attend the online seminar as well.
4) Obtain a letter of medical necessity from your primary care physician.
This will include detailed information on your weight history, weight loss efforts, and any experienced obesity-related health conditions.
5) Meet with a registered dietitian to perform a nutritional evaluation.
6) Undergo a psychological evaluation.
A psychological evaluation is also required as part of the process. But be rest assured, this is not a test you can fail. We all want to make sure you are properly motivated and equipped to be successful both short and long term.
7) Time to send away!
Now that you have gathered all the appropriate documentation depending on your coverage criteria, it’s time to send it to your insurance company for approval! This will also include your detailed treatment attempts and any obesity-related health issues. You can expect the review process to take about a month or less.
8) Are you approved or denied?
- If approved, you will be contacted for scheduling by your bariatric surgeon’s office and you’re on your way!
- In the case of being denied, our staff is well equipped to handle this. Your surgeon will often conduct a “peer to peer” review with a medical director of the insurance company. Our success rate for getting approvals is high.
It may seem like hoop after hoop to jump through, but bariatric surgery insurance coverage is a reproducible process and our team helps you through each step. Our office will ensure a smooth process so we can accomplish your goals of weight loss and health improvement.