Without weight-loss surgery insurance coverage, you will pay between $18,000 and $22,000 for gastric bypass surgery. Adjustable gastric banding will cost between $17,000 and $30,000. Those who will need to be paid include the bariatric surgeon, the anesthesiologist, the hospital, the dietician, the nutritionist, the physical trainer, and the mental health professional.
Many have questioned how such a regiment can be paid for and found the answer to be that it cannot.
Weight-Loss Surgery Insurance Denial
Having health insurance does not mean that weight-loss surgery is covered in your policy. About one quarter of people seeking weight-loss surgery will be denied three times before they receive weight-loss surgery insurance approval. Weight-loss surgery denial by health plans and prerequisites that cannot be met are the main reasons people do not get weight-loss surgery. Oddly enough, insurance companies will pay for the health issues that are caused by obesity. If your insurance carrier denies your request for weight-loss surgery, appeal the decision. Another option is to take out a medical loan for weight-loss surgery.
Weight-Loss Surgery Insurance Coverage
Insurance companies who do cover weight-loss surgery will only approve the procedure if it is medically necessary. Different insurance companies have different criteria for defining medical necessity. Qualifying criteria might be morbid obesity for two years or more, a body mass index greater than 35 accompanied with heart disease or type 2 diabetes.
In addition, the patient must have a history of failed attempts at weight loss and participated in a program of nutrition and exercise that was overseen by a physician.
The Role of Your Doctor
Most insurance companies will want a letter from your bariatric surgeon and/or primary care doctor verifying a medical need for your weight-loss surgery. The letter must include your height, weight, and BMI. A history of obesity related illnesses will be needed, as well as a list of your current medications, a report about how obesity effects your daily living, and a history of exercise and failed dieting attempts.
Medicare Weight-Loss Surgery Insurance Coverage
Medicare is the government health plan for people who are sixty-five or older. Medicare will finance three types of weight-loss surgery provided the procedure is done at a facility that is recognized as a Center of Excellence by the American Society for Metabolic and Bariatric Surgery or a Level 1 Bariatric Surgery Center. Before Medicare approves the surgery they usually want patients to participate in a six-month weight-loss program that is supervised by their bariatric surgeon or primary care physician.
Approval for weight-loss surgery is not automatic, and is reviewed on a patient by patient basis. You can learn all about Medicare coverage for weight-loss surgery from the Medicare National Coverage Determinations Manual.
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