Top 5 Things to Know About Weight Loss Surgery Insurance Coverage

Posted by Jason Radecke on Fri, Jul 14, 2017

When it comes to weight loss surgery insurance coverage, it’s all in the details. It is critical to know what your particular insurance policy covers. Most major insurance companies have some version of weight loss surgery coverage, but this does not mean that you’re good to go and ready to set a date. There are many fickle and tedious requirements to be met first.

  • Familiarize yourself with your policy.

Whether it is by calling your insurance company directly or going through HR at work, it is essential to know what is and what isn’t covered. Insurance may only cover the procedure, but not the hospital stay or anesthesia. Check the back of your insurance card for the phone number to speak to someone or contact your local bariatric specialist’s office. They can often times check what coverage you have.

  • Know your minimum body mass index (BMI) requirements.

Most criteria for weight loss surgery insurance coverage will require a BMI above 40, however certain exceptions can be made. A BMI above 35 with a health condition related to weight may also qualify you. This can include (but is not limited to) obstructive sleep apnea, heart disease, Type 2 diabetes, and difficult-to-treat hypertension.

  • Keep up with your appointments!

Many of the requirements for weight loss surgery insurance coverage include meeting with specialists – a lot of them. Generally, your surgeon’s office can help to coordinate these appointments, some of them even offering in-house personnel. Expect to complete all of the following:

  • Completion of a medically supervised diet program (approximately 3-7 months long).
  • Schedule a personal consultation with a bariatric surgeon to see which operation is right for you.  
  • Meet with a primary care physician to obtain a letter of medical necessity.
  • Meet with a registered dietitian to perform a nutritional evaluation.  
  • Completion of a psychlogical evaluation. National Institute of Health (NIH) guidelines state that you must be issued mental health clearance letter before undergoing bariatric surgery.  

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  • Be ready to wait.

The process as a whole can take up to a 6 to 7 months. You will have many appointments to attend and keep record of and that will require months of preparation and coordination. The review process alone for everything you send in to your insurance company can take almost a month.

  • In the case of being denied, you can attempt to appeal the denial.

Sometimes missing or inaccurate information may lead to a denial. That is why it is very important to take your time in making sure the information you send out is as accurate and thorough as possible. Make sure to follow all the appeals guidelines listed for your insurance company and keep records of any and all correspondence.

Getting your weight loss surgery insurance coverage approved is not an insurmountable task. Being prepared and knowing what is expected of you on behalf of your insurance company is generally all it takes. Keep organized and you’ll be well on your way to completing your weight loss surgery. An open line of communication with your bariatric specialist's office will help tremendously since they are trained to deal with this process daily.

 

Tags: Weight Loss Surgery Covered by Insurance

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