Understanding Weight Loss Surgery Insurance

Studies have proven that in the past 10 years the rate of obesity (usually 20 percent or more over a person’s ideal body weight) has tripled. It’s a fact that obesity leads to many other health problems such as diabetes, high blood pressure, sleep apnea, and arthritis. Because of this information, weight loss surgery is becoming more common. Here’s some interesting info on insurance for weight loss surgery.

Why Opt for Weight Loss Surgery?

Weight loss surgery is not to be taken lightly. The patient must have valid reasons for considering this major surgery such as trying continually to lose weight but failing or having a life threatening disease. Other reasons include a high risk for disease or having a genetic condition that results in obesity. Medical journal articles point out that weight loss surgery may even increase a person’s lifespan.

Different Weight Loss Surgeries

All weight loss surgeries are not the same. For instance, the Lap-Band does not require any incision on the stomach. Rather a band is placed on the stomach to shrink it and give it a full feeling sooner than before. Bypass surgery, one of the more popular procedures, is more invasive and requires incisions on the stomach and small intestines. Sleeve gastrectomy uses a stapling device to make the stomach smaller and, like the Lap-Band, creates a full feeling leading to less food intake. All are proven effective, and choices depend on needs and the advice of a physician.

Learn Whether You Have Coverage

The first question a weight loss surgery candidate might ask is whether medical insurance covers the procedure. Since the wording of a policy can confuse the reader, it’s best to discuss the matter with the insurance agent. Ask direct questions such as: “Is weight loss surgery (sometimes called bariatric surgery) covered in the policy I hold?” If the answer is yes, the next step is to double check on the amount of deductible and co-payment on the policy. Have you met the deductible for the year? When does the deductible renew? By asking direct questions, you’ll quickly learn whether or not the coverage is in place.

Coverage Requirements

Not every person who is overweight is a candidate for weight loss surgery. A number of requirements are listed, not only by the physician, but also the insurance company. The candidate for weight loss surgery must have no history of alcohol or drug abuse and no untreated mental disorder. Most candidates already have an obesity-related condition such as type 2 diabetes or high blood pressure. Candidates must agree to commit to a healthy, active lifestyle and cannot have a medical condition that might cause complications after surgery.

What If Coverage Is Denied?

To prevent being denied, take care that all documentation is covered. The weight loss surgeon and the primary-care physician must submit letters of medical necessity. The insurance company may also ask for a nutritional consultation and psychological evaluation. The surgeon will make these referrals. If the pre-approval is still denied, appeal. The appeal letter should be business-like and totally factual. Explain why you disagree with the decision and enclose proper documentation. Follow the letter with phone calls. Oftentimes, appeals can make the difference.

Statistically, weight loss surgery has changed many lives for the better. Those in the medical profession agree that quality of life is greatly enhanced following such a procedure. Insurance companies that cover the procedure have exact requirements for approving the surgery.