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How To Get Insurance For Bariatric Surgery

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How To Get Insurance For Bariatric Surgery

Many people who are considering weight loss surgery discover that getting approval for the procedure from their insurance company is one of the many high points in their journey to better health.

A growing number of insurance companies are coming to the realization that weight loss surgery results in enormous long-term financial savings for their clients. If you have cardiovascular disease, your medication and various tests and exams will be an ongoing cost to your insurance company. However, if the company covers the cost of a gastric bypass, the total amount of insurance coverage given to you will be far less than the costs of a lifetime of heart medications and possible hospitalizations.

If only getting insurance coverage for bariatric surgery were that simple. The truth is that getting an insurer to cover a major weight loss surgery can turn into one of the biggest hurdles a patient will have to face.

Recent years have seen a significant rise in the number of approval requests for bariatric surgery. Some 16,200 weight loss surgeries were performed in 1994; just a decade later, an 800% increase was reported, with 140,640 weight loss surgeries conducted.
Bariatric surgeries vary in cost, but the average expense is about $25,000. With the rising cost of the procedures and the rising number of people wanting them, insurance companies have had to tighten their requirements for approval in an attempt to deny some people coverage.
Unfortunately, insurance companies that fall into this category are taking a short-term view of this situation, as they are willing to let their clients switch to another insurance carrier rather than bear the cost of expensive medical procedures.

To be a likely candidate for approval, you must present a variety of information to your insurance company. Initially, you will need a “letter of medical necessity” from your primary care doctor and your bariatric surgeon that includes the following information:

  • Your height, weight history, and body mass index (BMI)
  • A listing of any health conditions related to your obesity, including treatment records
  • A detailed explanation of the limitations obesity has placed on your daily life
  • The history of your previous attempts at dieting – both medically supervised programs and non-medically supervised diets
  • A list of the various exercise programs you have participated in, including receipts for memberships in gyms or health clubs

Your doctor may also want to make a case for your need for this type of medical treatment, using supporting references taken from medical journals on the effectiveness of bariatric surgery. It would be helpful to include information that proves the role of weight loss in reducing or eliminating other health conditions.

A psychological evaluation and a nutritional consult may be required by some insurance carriers. You can ask your surgeon to give you referrals to experienced psychologists and nutritionists. In addition, many insurance companies also ask for documentation that you have tried a doctor-supervised diet program. This would require no less than six months’ of the supervising doctor’s your doctor’s office notes, which would list weigh-in information.

You should be aware that weight loss surgery is frowned on by some primary-care doctors. If you find this to be true, take heart. You can collect information on bariatric surgery to give to your doctor that may change his view on the subject. And if you can’t persuade your primary care doctor to agree to the surgery, you may need to go to a different primary-care physician who does believe in the efficacy of bariatric surgery – and that you could benefit from it.

It is also important for you to get documentation from any doctors who have treated you for conditions stemming from your weight, and have these records send directly to you rather than to your primary-care physician. This will help you to know whether or not these physicians support your request to have weight loss surgery. Also, make sure your bariatric surgeon has received any medical information that documents any health problems you have that are associated with morbid obesity, including diabetes, high blood pressure, cardiovascular disease, arthritis, sleep apnea, gastresophageal reflux, infertility, stress-related incontinence, high concentrations of lipids and cholesterol in the blood, and any other conditions that can be linked to obesity.

You must also give your surgeon other information, such as your weight history (to illustrate the history of morbid obesity), any medications you currently take, allergies, musculoskeletal history (broken bones, osteoarthritis, and joint pain), and your psychiatric history.

If you are approved for insurance for your weight loss surgery, it’s essential for you to thoroughly understand your policy. And if you have questions about how your surgeon handles insurance and financing issues, talk to someone in the surgeon’s office so that you can get any questions answered accurately.

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