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Medical Insurance


Will insurance cover weight-loss surgery?

  • Since every insurance policy is unique, it's important that you thoroughly understand your certificate of coverage to know exactly what is and isn't covered through your plan.
  • To qualify for insurance coverage, many insurers require patients to have a history of medically supervised weight loss efforts.
  • Keep track of every visit you make to a healthcare professional for obesity-related issues or visits to supervised weight loss programs. Make note of other weight loss attempts made through diet centers and fitness club memberships. Keep good records, including receipts.
  • If your bariatric surgeon recommends bariatric surgery, he or she will prepare a letter to obtain preauthorization from your insurance company. The goal of this letter is to establish the medical necessity of bariatric surgery and gain approval for the procedure.

The following information is generally included in the preauthorization letter:

  • Your height, weight, and Body Mass Index, and any documentation you might have as to how long you have been overweight.
  • Simply describing your condition as morbid obesity is not enough. A full description of all your obesity-related health conditions, including records of treatment, a history of medications taken, and documentation of how these conditions affect your everyday life, is necessary.
  • A detailed report of how your excess weight affects daily activities, such as walking, tying your shoes or maintaining personal hygiene.
  • A detailed history of the results of your dieting efforts, including medically and non-medically supervised programs, medical records, and records you may have kept of payments to and meetings you've attended with commercial weight loss programs.
  • A history of exercise programs, including receipts for gym memberships.
  • Ask your doctor to include clinical information about how effective bariatric surgery can be, particularly the control or loss of obesity-related health conditions.
  • Normally, your insurance provider will respond to your request within 30 days. You should schedule a follow-up if you have not heard from your insurance company in that amount of time.
  • If your insurance company denies your request, you can make an appeal. At this point, consider hiring an insurance lawyer or insurance advocate, both of whom can be very helpful. The insurance lawyer or advocate should have an in-depth understanding of the appeals process, as well as any laws that apply, and how to go about responding to the insurance company. With some insurance carriers, the number of appeals that you can make is limited. So be sure to learn as much as possible about the appeals process ahead of time.
 
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