Is My Bariatric Surgery Covered by Insurance?

Bariatric surgery for weight loss can be a life-saving procedure for people with severe obesity, but it is not cheap. While there are a number of insurance companies that cover these procedures, many medical insurance providers are hesitant to pay because of the large cost. Before you seriously consider weight loss surgery as an option for the management of your obesity, it is better to contact your insurance company to verify if bariatric treatment is covered by your policy. Some insurance policies (very few, now) exclude all kinds of weight loss surgeries. If there is no such specific exclusion in your policy, you should still contact a representative of your insurance company to verify whether the benefit of weight loss surgery coverage is available.

 

It is important to keep in mind that there are several grades or levels of obesity. Many insurance policies will exclude bariatric surgery for simple obesity but will cover treatment for severe, morbid or super obesity (unfortunate terms but they are currently used in medical practice). It is very important to be specific when dealing with insurance companies. If a procedure is a covered benefit, they may ask you to meet the specific requirements before they will authorize the treatment. Prepare for a long process. It may require a lot of effort on the part of the surgeon, the office staff and you. 

Insurance companies may ask for a letter from a doctor outlining a patient’s weight loss history and also the medical necessity for the surgery before they consider financing for the procedure. Even with the letter, many insurance companies may still refuse to authorize the surgery. If this is the case, most insurance providers provide patients with an opportunity to appeal a denial, requiring them to file an appeal within 30-60 days after receiving the denial of coverage. The appeal letter for bariatric surgery insurance should include information arguing against the insurance provider’s reason for denial but providing ample support for the medical necessity of the procedure. It is also helpful to include information about any obesity-related diseases so that the cost of treating these can be compared with the cost of the surgery itself.

For patients without insurance, there are a number of financial alternatives available. Various offices offer financing or payment plans for healthcare expenses for procedures not covered by medical insurance. Some may offer same-as-cash, no-interest plans and also extended payment plans. Some bariatric surgery centers even have contract with financing companies to offer financial assistance to patients who want to undergo this type of surgery, but don’t have the insurance to pay for it. If you do decide to pay “out-of-pocket” as it is called when a procedure is not covered by surgery, it is critical to get an itemized breakdown of the exact cost of all parts of the procedure including pre-operation evaluation, surgical costs, anesthesia costs and post-surgical visits.