Many insurance policies cover bariatric surgery procedures if they determine it is medically necessary for you. However there are insurance policies that exclude bariatric surgery in their policy. Whether you have coverage or a policy exclusion depends not on your insurance company but your employer’s group policy guidelines. If there is a policy exclusion for bariatric surgery your insurance company will NOT cover bariatric surgery under ANY circumstances
even if it is medically necessary. Self-pay and financing your procedure are the only choices at that point. The cost of bariatric surgery had come down over the years and it is affordable for many patients because they are able to finance the procedure.
First step is to check for your benefits on your policy and your insurance requirements for authorizing the procedure.
Our office will call your insurance company upon your instruction to verify benefits, approval requirements and pre-determination process.
Within 1-2 business days of completing the form our office will call you to explain your benefit details and surgical consultation is scheduled.
After surgical consultation and accomplishing all of the insurance requirements the letter of medical necessity is prepared.
At this point we will be waiting for YOU to help us obtain:
- Copies of previous weight loss attempt receipts
- Past 5 year medical records from your physicians
- Documentation of medically supervised weight loss if required by your insurance company
- Any other evaluations as needed by your insurance (most often a psychological, nutritional and exercise evaluations are needed)
- Any supporting letters from other physicians
- Once we obtain all documents and complete the package we will send all the information to your insurance company.
- It can take anywhere from 1 – 3 weeks for your insurance company to respond back and sometimes longer. As soon as we hear from the insurance we will contact you.
- Once an approval comes through we will move forward with the preoperative process and can schedule the surgery in about 2 weeks from the approval date.
- If insurance needs additional documentation we will notify you and you then need to obtain the additional documentation necessary. We will help you with that process.
- If insurance denied the application then you may appeal. However most appeals are denied unless you fulfill all the requirements by the insurance company and that we were able to provide documentation.
- If insurance coverage is denied or is not an option, then you may forward as self-pay. We can schedule your surgery date within 2-3 weeks from your decision to move forward as a self-pay patient.
- We will work with your primary care physician to get most of the pre-operative testing done in order to minimize your out of pocket costs.
- You may call our office or your insurance company at anytime in order to check the status of your application.
- Our office will keep up with the insurance company in order to get expedited approval process on your behalf.