Type of Surgery
Preparing for Weight Loss Surgery: Insurance Issues
Last updated: 04/01/2009
Preparing for Bariatric Surgery: Insurance Issues
For many people bariatric or weight loss surgery is their last and only hope of achieving a healthy weight. Bariatric surgeries are a means of treating obesity. As people weigh more than the normal weight for their height, the risk obesity-related illnesses increases considerably. Being overweight or obese can eventually lead to further complications like artery blockage, heart ailments, arthritis, hypertension, mobility issues and many more.
Conventional weight loss programs involving regular exercise and healthful diet may not work for every person struggling with obesity. Bariatric surgery is an option after other means of losing weight have failed. In fact, general guidelines for bariatric surgery stipulate that in order for the surgery to be medically necessary, an honest effort to lose weight through non-surgical means is faithfully attempted without success.
Since most medical insurances will only cover or pay for surgical procedures that are considered "medically necessary", bariatric surgeries are considered a gray zone. Insurance companies will not approve (and fund) a bariatric surgery unless the potential expense of long term obesity-related illnesses outweighs the cost of the surgery. For this reason, weight loss surgery is usually open only to those who have a BMI (body mass index) of 40 kg/m2 or above. If the patient has a serious weight related illness, such as Type 2 Diabetes Mellitus, than most insurance companies will pay for the surgery if the patient’s BMI is 35 or above.
Just because a surgeon feels that it is medically necessary to perform weight loss surgery does not mean that your specific medical insurance provider feels that same way. Since some bariatric surgeries cost $20,000 or more, it is critically important to know if you qualify ahead of time. In order to make sure, you should inquire with your insurance company regarding this matter for any possible weight loss surgery. It is important that every part of the procedure is explained to you by your surgeon and, just as importantly, every part is pre-approved by your insurance company. Do not be afraid to ask for things in writing. In fact, you should insist upon it.
If your insurance company denies approval for the surgery, you should not lose hope. In many cases, some additional information provided by your doctor in the form of appeal letter can result in approval by the insurance coverage. Many hospitals have insurance specialists on staff who can help you win insurance company approval. You may have to ask, though.
Remember that some of your records may be required by the insurance company prior to coverage approval. These can include a detailed diet history, weight, current height and BMI. Also a list of all co-morbidities (disease occurring at the same time) that are or could be caused by your obesity will be included. In addition a thorough medical history, psychological evaluation, a recent, medically supervised diet history, internal medicine clearance and certain medical tests may need to be proffered.
Last Updated: 04/01/2009
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