Insurance Gastric Bypass Surgery

An Insurance gastric bypass, is this possible? Good News! Although gastric bypass surgery is pretty expensive, your insurance company may actually cover you, so it’s worth checking out if this is the case for you.

Insurance coverage for weight loss surgery is widespread

With the National Institute of Health implementing a criteria that can be met for obese people to have gastric bypass surgery, many US states have now made it law for insurance companies to include this kind of operation within a client’s cover.

The problem is, it’s still an overly complicated process to get approval, so you should work in conjunction with the surgeon looking after you, as well as experts in the field.

2 fees to consider for insurance gastric bypass

Depending on what you have done will determine the cost of the operation. However, you need to be aware that both the surgeon and the time spent in hospital has to be paid for, and you also need to take into consideration that you may be off work for up to 6 weeks. If you choose to use a self-pay method, you need to speak to the insurance co-ordinator at the Bariatric Centre.

Medical Necessity

To qualify for gastric bypass insurance coverage, there are a variety of decisions that need to be made; the most important one being is your need for surgery life threatening. Your doctor or physician, a gastric surgeon and a specialist usually discuss this.

You will also need to undergo a thorough medical, as well as a full BMI test to determine how your body mass relates to your height and weight. Add into that what your diet has been for the previous two years, and you can see how in-depth it is. However, at the end of it, if you qualify then your doctor will recommend your insurance company.

Key Steps for insurance gastric bypass coverage

· Ensure that you understand the Certificate of Coverage, which explains your insurance cover, and you are entitled to by law.

· Speak with your doctor or physician first, as they will need to refer you to a specialist before you can really proceed to the next stage.

· Have all your medical, dietary and any other documents required in order, ready to present to the specialist.

· Keep a record of any visits to health institutes to try combat your obesity, as well as any other diet or fitness centres you’ve tried in an attempt to lose weight.

· Once your doctor has recommended the surgery, get him or her to send a letter to your insurance company, pre-authorizing the operation. This will help prove how you medically need this type of surgery, and will ensure the insurance company allows it.

Insurance Denials

If your insurance company does not approve the pre-authorization, there’s no need to despair. The first thing you can do is appeal against the decision, and you should do this as quickly as possible. You should also seek out the aid of a specialist insurance lawyer, who can guide you through the appeal process, since it can be quite an arduous and complicated process. Most of all, make sure you know how you’re going to approach the appeal, since there are limits as to how many times you can appeal.



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