Dr. Bass and the team from Gulf Coast Bariatrics have prepared this article on bariatric surgery cost to help you navigate insurance and finance this investment in your health.
The majority of states now require health insurance companies to provide weight loss surgery benefits to those who qualify for the procedure under the criteria of the National Institutes of Health. Despite this fact, getting approved can still be a lengthy process and the amount of reimbursement received varies widely. Additionally, many insurance companies have strict requirements for bariatric surgery that bar many people from qualifying.
The tips below can help you get approved by your insurance company for weight loss surgery benefits.
Make sure you understand your insurance company’s certificate of coverage
A certificate of coverage is a document that details the health benefits of your insurance plan and can typically be obtained from your employer or from your insurance company directly. Be sure to read your certificate of coverage and make sure you understand the benefits of your specific plan. It will outline coverage and bariatric surgery cost.
Get authorization or a referral to visit Gulf Coast Bariatrics
Your insurance carrier may require an authorization from your primary care provider before your initial consultation with Gulf Coast Bariatrics.
Document conversations with your insurance company
Be sure to keep detailed records of each conversation you have with representatives of your insurance company about medical weight loss. Writing down the name of the employee you speak with, the date and time of the conversation, and a brief summary of the information you are given will help you remember eligibility requirements. The information may also be useful if they try to reverse their claim later.
Keep track of all weight-related expenses
Provide documentation of every trip made to medical professionals for treatment of health issues related to obesity in the past few years. Hold on to receipts for diet centers, fitness clubs, or any weight loss programs you may have joined. This documentation may be useful later when negotiating the bariatric surgery cost.
Get help from your primary care physician or bariatric surgeon in the insurance authorization process
We will help you with the insurance authorization process if you are an appropriate candidate for weight loss surgery. Typically, we need written documentation from your primary care physician that shows bariatric surgery is medically necessary.
Your physician will need to provide us with documentation that you:
- Have a BMI of 40 or higher and are morbidly obese, or have a BMI of between 35-39.9 and weight-related health issues that may be life-threatening, like sleep apnea, high blood pressure, heart disease or diabetes.
- Have been seriously overweight for 5 or more years.
- Have attempted other forms of medically supervised weight loss treatments for two years without success, such as behavioral support groups, weight loss medications, or programs like Medifast® or OPTIFAST®.
- Have had no history of alcohol or substance abuse.
- Have received a thyroid test and will supply the results to the surgeon.
The letter should also specify whether or not you have a serious liver, kidney, or gastrointestinal disease.
What if the coverage request is denied?
Your insurance company is required to allow people to make appeals to coverage rulings. Be sure that you understand why your coverage request was denied and appeal the decision quickly by addressing the company’s specific concerns with accurate documentation.