Insurance for Weight Loss Surgery
We gladly accept standard fees from most insurance companies. Every weight loss surgery program has a similar set of criteria for accepting patients, which includes checking Body Mass Index and suitability for surgery. However, if the patient wishes to finance part or all of their surgical costs through their insurance plan, insurance companies will have a slightly different set of criteria for coverage. Most insurance companies, with the exception of Medicare and Medicaid, will allow for a preauthorization and verification of insurance benefits, giving the patient a decision on their eligibility beforehand.
In order to get a pre-approval from your insurance company, they will ask for documentation to prove that the procedure is a medical necessity. In order to find out what these requirements are, and to see if you qualify for bariatric surgery at all, you should promptly contact your insurance company.
Some of these requirements may include:
- Consultation with a weight loss surgeon
- 3-6 months of physician supervised medical weight loss
- Evidence of past diet and exercise programs
- Cardiac and Psychological suitability
- A detailed food journal
- A letter of medical necessity from your primary physician
- Evidence of obesity related diseases
Dealing with the insurance company may be a long and sometimes frustrating process, however, submitting a complete and accurate application will generally effect a speedier approval.
If you do have insurance coverage for surgery, that may not mean your financially responsibility is zero for surgery. Typically, insured patients are responsible for a copay amount or percentage of their surgical cost. You may also have a deductible to meet before coverage triggers. The timing, facility, and other factors may impact your overall cost.