Losing weight is a challenging task. If you can’t lose weight through exercises and diet, you can opt for weight loss/bariatric surgery. There are several things you should know before undergoing the procedure with your Merritt Island bariatric surgeon.
Some health insurers may not pay for bariatric surgery despite recommendations from the doctor. Most health insurers prefer paying costs incurred in treating conditions associated with obesity. The cost of bariatric surgery depends on several factors such as the type of surgery, surgeon fees and the hospital performing the surgery.
There are several types of bariatric surgery and each type is charged differently. These surgeries include sleeve gastrectomy, adjustable gastric banding, stomach stapling or vertical gastric banding, gastric bypass and biliopancreatic diversion. The surgeon’s fee will depend on his/her expertise, the complexity of the procedure and where you reside. You can also incur costs such as surgical assistant’s fee, anesthesiologist’s fees and device fees, among others.
Will Your Insurer Meet the Costs?
Before undergoing weight loss surgery, you should read your health insurance policy carefully. Ensure that you seek the assistance of your insurer and doctor so that you can understand the policy well.
A good number of insurance companies appreciate the fact that most overweight/obese people are prone to high blood pressure, sleep apnea, high cholesterol and type 2 diabetes. Studies show that bariatric surgery can solve about 30 conditions associated with obesity.
People without health insurance will probably meet the entire cost of the surgery by themselves. However, they can get loans with the help of some surgery centers.
Requirements for Your Insurer to Pay for Bariatric Surgery
Most insurers will ask for a full medical work-up. This medical work-up requires a psychological and nutritional evaluation. The psychological evaluation ensures that the patient understands and knows the effects of bariatric surgery.
It also checks for other psychological issues such as untreated binge eating. During the nutritional evaluation, a nutritionist will guide you on what diets and habits you should change.
The insurance company may also require proof from the surgeon to show that the surgery is medically necessary. It may also require you to participate in a diet program supervised and documented by a physician. Not all insurance firms request for this program. However, some insurers request you to participate in this program so that they can determine if you can commit to lifestyle changes after weight loss surgery.
After fulfilling these conditions, the surgeon will send a pre-authorization request to the insurer. This letter shows your medical history, health conditions arising from your weight and documentation to show you have completed all steps needed for approval. After receiving the letter, the insurance firm will review your request and either decline or approve it.
If your request is rejected or the insurer agrees to meet a small fraction of the cost, you can appeal the decision. The appeal process requires you to provide more documentation to show that the surgery is medically necessary. Most health insurance plans have a clear appeals process. Insurance companies require you to appeal within given timelines, maybe before 60days. The firm may also require you to lodge a phone complaint before writing an appeal letter.
During the appeal process, you should keep records of your appeal and all communication with the insurer. There are two types of appeals; external and internal. An internal appeal is to the insurance firm while an external appeal is lodged at your state department of corporations or insurance commissioner. Your bariatric surgery can offer you assistance during the appeal.
You can also ask your surgeon or doctor about other financing plans if your insurer declines to meet the cost of the surgery.