F.A.Q. about Surgical Weight Loss
For many people, bariatric surgery is affordable because it is covered by their health insurance plan. People who do not have insurance coverage for bariatric surgery must pay for it on their own. This is called self-pay or cash-pay. Cynthia, a gastric bypass patient featured in Real Patients’ Stories, paid for her own surgery and considered it a critical investment in her health.
Whether you have health insurance or opt for self-pay, you will need to prepare detailed written documentation. From diet history to co-morbid conditions, this information will come in handy.
Quick Fact: Getting Approved
Write a description of how morbid obesity decreases the quality of your life. Be sure to include details such as difficulty walking, socializing, or maintaining personal hygiene. This documentation can be useful for your bariatric program and health insurance company.
How to Work with Insurance
Working with Health Insurance
Many people find dealing with health insurance companies to be intimidating and are not sure how to even get started. If your bariatric surgeon recommends surgery, consider the following:
- Your best resource for how to deal with your health insurance company may be your bariatric program. Many bariatric programs have patient advocates who work on your behalf with your health insurance company.
- Read your Certificate of Coverage (COC). A COC describes your insurance policy in detail, including what it covers and what it excludes.
- Write down your weight loss history. Go as far back as you can and include diets and exercise programs. If possible, pull together receipts for gym memberships and weight loss programs. [LINK TO 1.10.5 RESOURCE LIBRARY: DIET HISTORY]
For more assistance, find a bariatric surgeon and program using the surgeon locator.
Appealing a Denial
If the insurance company turns down your request for bariatric surgery, you may be able to appeal the decision. Many people do not take advantage of the appeals process or know of the laws that govern insurance companies in their state.
Work with Your Bariatric Program
Assistance is key. It is critical that you work with your bariatric program to determine the correct approach to appealing a denial. Your program is there to assist you and to help you adhere to your policy’s requirements.
Tip:
Write a description of how morbid obesity decreases the quality of your life. Be sure to include details such as difficulty walking, socializing, or maintaining personal hygiene. This documentation can be useful for your bariatric program and health insurance company.
Possible Options After Appeals
Even if you exhaust the appeals options, you still may have options:
- Independent review board: This is an option available to people in more than 40 states and doesn’t require a lawyer. Judgments usually are issued in 60 days. Check your state’s website for specific filing instructions.
- Arbitration: Some health insurance companies require patients to use a third party—other than the patient’s lawyer and the insurance company—instead of going to court.
- Litigation: This option is expensive and takes a lot of time.
For more assistance, find a bariatric surgeon and program using the Physicians by Procedure page
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