How To Get Insurance To Pay For Your Bariatric Surgery

Insurance Coverage for Bariatric Surgery

Figuring out how to pay for your bariatric procedure is a major obstacle for many patients. With costs ranging from $15,000 to $50,000, insurance coverage is a major factor for most patients. We'll help breakdown the process to make things go as smoothly as possible for you on this new journey.

Checking Your Policy

Before pursuing bariatric surgery, it's important to review your insurance policy to determine if the procedure is covered. Many insurance providers cover weight loss surgery under certain conditions. You can check your policy documents or contact your insurance company directly and speak with an agent, who can walk you through the fine print of your policy and what’s covered. 

Requirements for Coverage

Insurance companies typically require certain criteria to be met in order to approve coverage for bariatric surgery. These may include:

• A body mass index (BMI) of 40 or higher, or a BMI of 35 or higher with at least one obesity-related health condition (e.g., type 2 diabetes, high blood pressure, sleep apnea)
• A history of unsuccessful attempts at non-surgical weight loss through diet and exercise
• Completion of a medically supervised weight loss program
• A psychological evaluation to ensure the patient is mentally prepared for the surgery and lifestyle changes

Both Medicare and Medicaid cover some bariatric procedures, including gastric bypass surgery and laparoscopic banding surgery, for patients who meet these criteria. A supervised medical weight management program may be required before surgery approval.

Out-of-Pocket Expenses

Even if your insurance covers bariatric surgery, you may still have out-of-pocket expenses, such as deductibles, copayments, and coinsurance. It's essential to budget for these costs and understand your financial responsibility before proceeding with the surgery.

Steps to Get Insurance to Pay for Bariatric Surgery

Step 1: Consultation with a Bariatric Surgeon

The first step in the process is to consult with a qualified bariatric surgeon that is within your plan network, who can evaluate your situation, discuss the available options, and help you determine if you're a good candidate for the surgery. Make sure to choose a surgeon who is experienced in dealing with insurance companies and can guide you through the necessary steps to secure coverage.

Step 2: Medical Necessity Documentation

To obtain insurance coverage for bariatric surgery, you'll need to prove that the procedure is medically necessary. This typically involves gathering documentation from your primary care physician, the bariatric surgeon, and other medical professionals to demonstrate that you've met the required criteria. This may include records of your weight loss history, BMI measurements, and proof of participation in a medically supervised weight loss program.

Step 3: Preparing a Preauthorization Request

Once you have all the necessary documentation, your bariatric surgeon or their office will prepare a preauthorization request to submit to your insurance company. This request should include a detailed treatment plan, along with all the supporting documentation. The insurance company will review the request and either approve or deny coverage. This process can take several weeks, so it's important to be patient and prepared for possible delays.

Step 4: Appealing a Denied Claim

If your insurance company denies coverage for your bariatric surgery, don't lose hope. Many denials can be successfully appealed with additional information or clarification. Work closely with your bariatric surgeon and their office to gather any additional documentation needed and submit a well-crafted appeal letter. Keep in mind that the appeals process can be lengthy, so it's essential to remain persistent and follow up regularly with your insurance company.

Alternatives to Insurance Coverage

Self-Pay Options

If your insurance does not cover bariatric surgery, or if you don't have insurance, self-pay options are available. Some bariatric surgery centers offer package deals for self-pay patients that include all the necessary preoperative tests, the surgery itself, and postoperative care. Be sure to research and compare prices among different providers to find the best option for you.

Medical Loans

Another alternative to insurance coverage is taking out a medical loan to finance your bariatric surgery. Many financial institutions offer loans specifically designed for medical procedures, with competitive interest rates and flexible repayment terms. Make sure to research different lenders and compare loan offers to find the best fit for your financial situation.

FAQs

1. Do all insurance plans cover bariatric surgery?

No, not all insurance plans cover bariatric surgery. Coverage depends on the specific policy and provider. Be sure to review your policy documents or contact your insurance company to determine if your plan covers the procedure.

2. How long does it take to get insurance approval for bariatric surgery?

The approval process can vary depending on the insurance company and the complexity of your case. It can take anywhere from a few weeks to several months for your insurance company to review your preauthorization request and make a decision.

3. What if my insurance company denies coverage for bariatric surgery?

If your insurance company denies coverage, you have the option to appeal the decision. Work with your bariatric surgeon and their office to gather any additional documentation needed and submit a well-crafted appeal letter. Be prepared for a potentially lengthy appeals process and remain persistent in your efforts.

4. Can I get bariatric surgery if I don't have insurance?

Yes, you can still get bariatric surgery without insurance. You'll need to explore self-pay options or consider taking out a medical loan to cover the costs of the procedure. Be sure to research and compare prices among different providers to find the best option for your financial situation.

5. Are there any additional costs associated with bariatric surgery that I should be aware of?

Aside from the cost of the surgery itself, there may be additional expenses, such as preoperative tests, postoperative care, nutritional supplements, and potential complications that may require further treatment. It's important to discuss these potential costs with your bariatric surgeon and prepare a comprehensive budget to ensure you're financially prepared for the entire process.

Author: Allison Eisenberg Allison is a certified nutritionist and author with over 15 years of experience writing in the health and weight loss industry. She is passionate about helping people achieve their goals through proper nutrition and exercise. As a certified nutritionist, Allison has worked with clients from all walks of life and helped them make positive changes to their diet and lifestyle. In addition to her work as a nutritionist, Allison is also the author of multiple health and wellness blogs, where she shares her expertise and insights on topics such as healthy eating, weight loss, bariatric medicine, and exercise habits. Through her writing, she hopes to inspire and empower others to take control of their health and live their best lives.

Reviewed By: Dr. K. Huffman Kevin D. Huffman, D.O. is a board-certified bariatric physician who has dedicated his career to treating obesity. With over 10,000 patients under his care, he has become a respected authority in the field of bariatric medicine. Dr. Huffman has trained and mentored hundreds of healthcare providers and is widely recognized as a national leader in the field. Dr. Huffman founded American Bariatric Consultants to develop treatment protocols and training materials. He has been sought out by medical societies, pharmaceutical companies, patients, and hospitals for his expertise in the art, science, and business of bariatric medicine. In addition to treating patients, Dr. Huffman prepares physicians for board certification in bariatric medicine, helping to expand access to this vital form of treatment.