Bariatrics - Insurance Information
Insurance Policy Information
Bariatric surgery is covered by many insurance companies, depending upon the type of policy you have and its terms and conditions. Insurance policies, even those issued by the same insurance company, vary in coverage.
If your policy covers bariatric surgery, your insurance company will require that certain criteria be met before they will authorize coverage. Please feel free to call our center with your insurance information and we will verify coverage, benefits, exclusions and the criteria that will need to be met prior to surgery. A policy exclusion means that weight loss surgeries are not covered under any circumstance. Most insurance companies require a surgical consultation, psychological evaluation, six month medically supervised diet, letter of medical necessity and a five year weight history.
Some patients may choose to pay for surgery on a self-pay basis. Financing options are available and the staff at the Bariatric Wellness & Surgical Institute can provide you with information on these programs.
Medical Necessity
If weight loss surgery is not an exclusion on your policy, authorization of your surgery depends upon the determination by your primary care physician, surgeon and sometimes a specialist, that bariatric surgery is medically necessary to reduce significant health risks to your life.
The following items will be obtained and submitted to your insurance company for medical review:
- Thorough medical history including co-morbidities
- Detailed diet history
- Current height, weight and BMI (body mass index)
- Psychological evaluation
- Documentation of six month medically supervised diet (if required)
- Five year weight history (documented by one or more of your physicians)
Insurance Denials
If you receive a denial of coverage by your insurance company, and weight loss surgery is not excluded on your policy, you should not consider this to be a "definite no". In many cases, providing detailed information may result in a denial being overturned. All companies have an established appeal process in place and our staff can provide guidance on how to initiate an effective appeal. If your insurance carrier continues to deny coverage you may want to consider seeking legal assistance. Insurance companies will often relent under these circumstances.