Does Insurance Cover Bariatric Surgery?
After the decision has been made to explore weight loss surgery, the next question we are commonly asked is, “Does insurance cover Bariatric Surgery?” If cash payment is not an option, the good news is that insurance will often cover various types of weight loss procedures.
What will insurance require for bariatric benefits?
First and foremost, remember that insurance coverage is determined by the policy, not the provider. Before attempting to decipher a policy, a good rule of thumb is to contact the insurance provider, identify the policy, then find out exactly where the policy stands on deductibles and coinsurance.
Most large insurance providers will want to know:
- Is bariatric surgery medically necessary? Providing medical history and evidence of weight loss difficulties will usually be required. The surgeon who will be performing the procedure can assist with providing documentation of weight-related health issues that could mandate fast and effective weight reduction.
- Have non-surgical weight loss programs been attempted? Many insurance companies require completion of a 6-month diet and exercise program before they will consent to a weight loss procedure. This is partly to determine whether or not the patient can successfully commit to a program not only before, but especially after weight loss surgery. Bariatric surgery is an investment toward improving the lifelong health of the insured, but if there isn’t sufficient proof that the patient is fully invested in doing their part to keep the weight off, the insurance company may hesitate to provide funding.
- Is the patient psychologically ready? Any major surgery will impact a patient’s life short-term. Weight loss surgery not only affect’s the life of the patient temporarily, but it also has a drastic effect on their long-term lifestyle. The insurance company will also want to find out if there are underlying problems which could contribute to binge eating or overeating that should be addressed beforehand.
After these items have been checked off the list, The Bariatric Experts sends a pre-authorization letter to the insurance company. The letter will describe the medical history of the patient pertaining to weight, and also outline the necessary requirements which have been completed to obtain approval. It is important to keep copies of all correspondence, forms, emails, and letters to and from the insurance company.
If the insurance company denies coverage, there is still the option of submitting an appeal to cover as much of the weight loss procedure as possible.
What are other options to pay for weight loss surgery?
If insurance is not an option, cash pay is not possible, or if coverage is denied, there are other financing plans available. It’s also important to note the financial savings patients experience, such as reduced medical and prescription costs and less money spent on food.
Call our Patient Care Managers at 940-577-2090 for information on which funding options may be accessible to you, if your insurance will cover your procedure, and what the drawbacks may be in paying for the procedure out of pocket or through an independent finance company. We’re here for you every step of the way to better health!