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Does Insurance Cover It?

Does Insurance Cover Bariatric Surgery?

Since obesity was officially recognized as a disease by the American Medical Association, more insurance companies are being asked to cover bariatric surgery. At Bon Secours Surgical Weight Loss Center, we understand that obtaining approval from your insurance carrier can be an emotional and complicated process. Our insurance analysts can help patients submit any necessary documentation.

The first step is to review your insurance policy or employer sponsored medical benefits plan. If you have an insurance policy that you pay for yourself – or that is paid in full or in part by your employer – or if you are covered by an employer’s self-insured medical benefits plan, your bariatric surgery may be covered by medical insurance.

Below are some frequently asked questions by weight loss surgery candidates:

1. What can I do to help the approval process?

Gather all the information (diet records, medical records, medical tests) your insurance company may require. This reduces the likelihood of a denial for failure to provide “necessary” information. Letters from your personal physician and consultants attesting to the “medical necessity” of treatment are particularly valuable, but do not use the letters to replace other documentation required by your insurance company.

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When the letter is submitted, call your carrier regularly to ask about the status of your request. Your employer or human relations/personnel office may also be able to help you work through unreasonable delays.

2. What if my insurance denies surgery after an appeals process?

The Bon Secours Surgical Weight Loss Center offers patients without insurance coverage the option of a self-pay package. Please contact the Center or your physician’s insurance coordinator for more information.

3. How can they deny insurance payment for a life-threatening disease?

Payment may be denied because there may be a specific exclusion in your policy for obesity surgery or “treatment of obesity.”

Insurance payment may also be denied for lack of “medical necessity.” A therapy is deemed to be medically necessary when it is needed to treat a serious or life-threatening condition. In the case of morbid obesity, alternative treatments – such as dieting, exercise, behavior modification, and some medications – are considered to be available.

Medical necessity denials usually hinge on the insurance company’s request for some form of documentation, such as 1 to 5 years of physician-supervised dieting or a psychiatric evaluation, illustrating that you have tried unsuccessfully to lose weight by other methods.

4. Why does it take so long to get insurance approval?

Once you have all of the necessary documentation and you submit it to your insurance company is can take 3-4 weeks to longer (if you are not persistent in your follow-up) to get an answer. The Bon Secours Surgical Weight Loss Center has insurance analysts who will assist you with your documentation submission and will follow up regularly on approval requests. It may be helpful for you to call the claims service department of your insurance company about a week after your letter is submitted and ask about the status of your request.

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