At some point, after you have spent a considerable amount of time exploring the option of weight loss surgery, you will need to determine how to pay for the procedure. A growing number of states have passed legislation that requires insurance companies to provide benefits for weight loss surgery for patients who meet the National Institutes of Health's surgical criteria. Despite this, the insurance pre-certification process is frequently a lengthy and complicated process.
Please check with your insurance carrier to see if they provide coverage for obesity surgery and the appointments that are required by our program. These required appointments are with the dietician, the health psychologist for evaluation and testing, and the physical/occupational therapist for a fitness evaluation. On occasion, some insurance companies will cover the surgery but not the required appointments. Other appointments that are not required but may need to be scheduled include: upper endoscopy, gallbladder ultrasound, breathing tests, evaluation for sleep apnea, and heart and/or lung evaluation.
On every insurance card, there is a toll-free customer service number to call for information regarding the benefits available under your plan. Some insurance companies provide an additional number on your card specifically related to health plan benefit information.
Steps to help your insurance process along:
- Read and understand the "certificate of coverage" that your insurance company is required by law to give you. If you do not have one, consult your company's benefits administrator or ask your insurance company directly.
- Organize your medical records, including your history of dieting efforts. They will be valuable documents to have at every stage of the approval process.
- Document "other" weight loss attempts made through diet centers and fitness club membership. Keep good records, including receipts.
Other reminders about insurance:
- Programs require a letter of recommendation from your primary/family doctor in support of you having bariatric surgery.
- If your surgeon recommends weight loss surgery, he or she will prepare a letter to obtain pre-authorization from your insurance company. Let your surgeon do this, NOT your primary care physician or you. The goal of the letter is to establish the "medical necessity" of weight loss surgery and gain approval for the procedure.
- Thirty days is the standard time for an insurance provider to respond to your request.