How to Know If Insurance Covers Bariatric Surgery

These days, most insurance companies will cover bariatric surgery when it is a medical necessity, and it is a good thing because bariatric surgery costs many thousands of dollars and is cost-prohibitive for most people who need it. Some insurance companies exclude coverage for any weight loss costs, however, and they refuse to cover any bariatric surgery. Getting approved for the surgery can be a long process. Read on to learn how to know if insurance covers bariatric surgery.

Difficulty: Moderately Easy

Instructions

1. Read your insurance policy closely for exclusions. Policies that will not cover any weight loss related charges specify that explicitly in the policy literature.

2. Get a complete medical work up. Insurance only covers medically necessary surgery, so you will need to demonstrate any conditions such as hypertension and diabetes that represent a threat to your life.

3. Talk to a psychologist. Most insurance companies and bariatric surgeons require a psychological evaluation before approving surgery. Some bariatric clinics employ a psychologist for this purpose.

4. Consult with a bariatric surgeon. Bariatric surgeons have a lot of experience working with insurance companies and they should be able to predict if your insurance company will cover your surgery and tailor your materials to that companies preferences.

5. Have your doctor submit all necessary materials to the insurance company. Good bariatric clinics will know what to do and tell you want you need to do. They may even have insurance specialists on staff to make the process run smoothly.

6. Talk to your doctor about financing options. When insurance won't cover the surgery or only covers a percentage of the cost, it is necessary to find other payment options. Your doctor can discuss alternative payment methods.

Tips & Warnings

• Don't take "no" for an answer. Even if your insurance company refuses to cover your surgery, you can still appeal the decision. Get your doctor to write a letter on your behalf.
• Consider switching to your spouse's insurance company if your policy has an explicit exclusion. Check to make sure your spouses insurance policy doesn't have the same exclusion.
• Use the tax deduction to offset costs if you have to pay for the surgery yourself. Medically necessary weight loss surgery is tax deductible.
• Try to get your insurance company to cover related expenses for the bariatric surgery such as testing if they won't cover the surgery itself.
• Choose a policy without a weight loss exclusion if you are switching policies. It's nearly impossible to get around and explicit exclusion.
• Know your co-payment and deductible for your policy. Even if your insurance covers the surgery, you may have to come out of pocket for these fees. Know what it is in advance so you are prepared to pay it.

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