Paying For Surgery

     These surgical procedures are very expensive and therefore, a growing number of states have passed legislation that requires insurance companies to provide benefits for weight loss surgery for patients that meet the National Institutes of Health surgical criteria. Insurance coverage for weight loss surgery is common; however it requires a lengthy and complicated approval process. The best chance for obtaining approval for insurance coverage is by working together with your bariatric surgeon and other experts to ensure your approval. The following are some of the key steps you should follow in order to get coverage for weight loss surgery:

* Read and understand the "certificate of coverage" that your insurance company is required by law to give you. If you do not have one, consult your company's benefits administrator or ask your insurance company directly.
* You may be required to start with your primary care physician. In some cases, he or she is the only one you can ask for a referral to a qualified bariatric surgeon. Even if you are not required to get a referral, it is a good idea to have the support of your primary care physician.
* Before visiting the bariatric surgeon, organize your medical records, including your history of dieting efforts. They will be valuable documents to have at every stage of the approval process.
* Document every visit you make to a healthcare professional for obesity-related issues or visits to supervised weight loss programs. Document "other" weight loss attempts made through diet centers and fitness club memberships. Keep good records, including receipts.
* If your bariatric surgeon recommends weight loss surgery, he or she will prepare a letter to obtain pre-authorization from your insurance company. The goal of this letter is to establish the "medical necessity" of weight loss surgery and gain approval for the procedure.

     The following information is generally included in the pre-authorization letter:

1. Your height, weight and Body Mass Index and any documentation you might have as to how long you have been overweight.
2. A description of your condition - in more detail than simply stating morbid obesity" is not enough. This description needs to include records of treatment, a history of medications taken and documentation of the effects these conditions have had on your everyday life is necessary.
3. A detailed description of the limitations your excess weight places on your daily activities, such as walking, tying shoes, or maintaining personal hygiene.
4. A detailed history of the results of your dieting efforts, including medically and non-medically supervised programs, medical records and records kept of payments to and meetings attended with commercial weight loss programs.
5. A history of exercise programs, including receipts for memberships in health clubs.
6. Information (that you can get from your doctor) from medical journals regarding the effectiveness of weight loss surgery, particularly information showing the control or elimination of obesity-related health conditions.

     Thirty days is the standard time for an insurance provider to respond to your request. You should initiate a follow-up if you have not heard from your insurance company in that time. If your request is denied you can go through an appeal process.

Related Links

Surgical Weight Loss
Restrictive & Malabsorptive
Different Procedures
Surgery & Success
Risks & Complications
What to Expect
Post-Surgery Diet
Follow-Up
Definitions