Health Insurance Approval

After exploring the options of bariatric surgery, you will need to determine how to pay for the surgical procedure. For many people, the surgery is affordable because it is included in their health insurance plan. People who do not have insurance coverage for bariatric surgery must pay for it on their own. This is called self-pay or cash-pay.

Our bariatric program will assist you in working with your health insurance provider and help you adhere to your policy’s requirements.

Here are some key steps for obtaining insurance coverage for bariatric surgery:

Keep ongoing documentation of:

  • Previous weight loss attempts including medically supervised diets, weight loss programs, and gym memberships
  • Co-morbid conditions
  • Current medications
  • Visits to healthcare professionals for obesity-related issues
  • How morbid obesity affects the quality of your life
  • Ask your bariatric surgeon for a letter stating the "medical necessity" of the surgery.

 

Increase your chances of obtaining approval for insurance coverage by working with your bariatric surgeon, your bariatric program, and your insurance provider. Provide them with as much information as you can. Include paperwork, medical records, receipts, etc.

Understand Your Certificate of Coverage

While every health insurance policy is unique, it is important to understand your Certificate of Coverage. Read your insurance policy in detail, including what it covers and what it excludes. If your insurance company denies your request for bariatric surgery, you may be able to appeal the decision.

Appealing a Denial

  • It is critical that you work with your bariatric program to determine the best approach for appealing a denial from your health insurance company. Even if you exhaust the appeals process, you may have other options:
  • Independent Review Board: This option is available in more than 40 states and does not require a lawyer. Judgments are usually issued in 60 days.
  • Arbitration: Some health plans require patients to use a third party instead of going to court.
  • Litigation: This option is expensive and time-consuming, and should be reserved as a last resort. Bariatric surgery is a major investment, so consider your resources and desire for the surgery.
  • Alternative financing: If your insurance policy does not cover bariatric surgery, you may want to exploreother financing options such as a medical loan.

 

How to Find Alternative Financing Options
Few people are able to pay cash up front for bariatric surgery. If you do not have health insurance and would like to have the surgery, you may want to explore alternative financing options.

Medical Loans
Many bariatric programs work with financing companies to offer a variety of loans to patients. Your program coordinator can tell you more about the specifics of the options, such as the length of the loan and interest rate.

Important Considerations

  • Depending on the financing company, large medical loans may require collateral such as your home.
  • Home equity loans may offer better interest rates.
  • When it comes to self-pay, you should consider the expense of potential surgery-related complications because these may not be covered by your insurance either. It’s a good idea to hope for the best and plan for the worst.

 

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