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Dealing With Insurance

You’ve considered all of your options for weight loss and want to help yourself become the person you’ve always wanted to be and knew you always were. But you need some help. You need emotional strength, guidance and of course, financial security – after all, who will pay for the procedure?

In most states, legislation requires insurance companies to provide benefits for weight loss surgery when patients meet the National Institutes of Health (NIH) criteria. But even though insurance coverage is widespread, you should prepare for a lengthy approval process.

Financial considerations need to be addressed because the cost of the bariatric weight loss surgery and follow-up differ according to the complexity of the operation. Most insurance companies approve benefits for the surgery if certain criteria are met, and these vary between individual insurances. Other companies, however, have exclusion clauses for the treatment of obesity.

Before you attempt to get authorization for coverage in the event of bariatric surgery, you should read and understand your insurance company’s "certificate of coverage." In many cases, you can get it from your employer’s benefits administrator or your insurance company directly.

You should also get a referral from your primary care physician if necessary. Even if you don’t need one, you must have your doctor’s support. Keep accurate, detailed records and save receipts.

Finally, it is in your best interest to document every visit to healthcare professionals for obesity-related issues, including weight loss programs, diet centers, and fitness clubs.

Waiting for insurance approval can be a strenuous and arduous ordeal. Nobody wants to be denied an opportunity at a second chance at life.  There are things that you can do to help facilitate your insurance approval process.

  1. Check with your surgeon to make sure that they have everything they need to submit your claim to insurance
  2. Follow up with your surgeon to make sure your paper work went out in a timely fashion.
  3. Follow up with your insurance company every few weeks to see how things are progressing

If your request for coverage has been denied, then the next step is to send in an appeal letter. It is good to have one of these already on hand, ready to be signed by your doctor/surgeon and sent in. Some insurers have been known to systematically deny all applications, only acting upon appeal letters or 2nd appeal letters.