insurance options

At some point, after you have spent a considerable amount of time exploring the option of weight loss surgery, you will need to determine how to pay for the procedure. A growing number of states have passed legislation that requires insurance companies to provide benefits for weight loss surgery for patients that meet the National Institutes of Health surgical criteria. Most insurance companies now cover weight-loss surgery for severely obese patients. Each insurance plan has its own specific set of requirements.

Here are some of the key steps you should take to see if you have obtain insurance coverage for weight loss surgery:

  • Read and understand the "certificate of coverage" that your insurance company is required by law to give you. If you do not have one, consult your company's benefits administrator or ask your insurance company directly by calling the 800 phone number on your insurance card or calling customer service.
  • You may be required to start with your primary care physician. In some cases, he or she is the only one you can ask for a referral to a qualified bariatric surgeon. Even if you are not required to get a referral, it is a good idea to have the support of your primary care physician.
  • Before visiting the bariatric surgeon, organize your medical records, including your history of dieting efforts. They will be valuable documents to have at every stage of the approval process.
The following information is generally needed by your insurance company:
  1. Your height, weight and Body Mass Index and any documentation about how long you have been overweight. 
  2. Simply describing your condition as "morbid obesity" is not enough. A full description of all your obesity-related health conditions, including records of treatment, a history of medications taken and documentation of the effects these conditions have had on your everyday life is necessary.
  3. A detailed description of the limitations your excess weight places on your daily activities, such as walking, tying shoes, or maintaining personal hygiene.
  4. A detailed history of the results of your dieting efforts, including medically and non-medically supervised programs, and exercise programs.
  5. Documentation from your primary care physician showing the lack of long term weight loss.

Our insurance specialist can assist you in all matters regarding your insurance.

 

The Appeals Process

Even if your initial request for pre-authorization is not approved, you still have options available. Insurers provide an appeal process that allows you to address each specific reason they have given for denying your request. It is important that you reply quickly Some insurers place limits on the number of appeals you may make, so it is important to be well prepared and that you clearly understand the appeal rules of your specific plan.

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