If you need bariatric surgery, it’s very likely you have already found out about its hefty cost. Fortunately, it’s possible for many patients to get weight-loss surgery through bariatric surgery insurance coverage. Even though you can usually convince your insurance company to cover the cost of your surgery, it will take a significant effort on your part. Getting coverage is only possible if you can meet the strict requirements put in place by the vast majority of insurance providers. If your insurance company is being stubborn about offering bariatric surgery financing, you may be able to get coverage by choosing an inexpensive procedure. This guide covers some of the things you need to know about getting bariatric surgery insurance and financing.
Research the Different Bariatric Surgical Procedures
Your weight loss surgery insurance company might attempt to steer you toward an inexpensive surgery, but that procedure might not be the right choice for you. Ultimately, you should never let your bariatric surgery insurance company coerce you into a surgery you don’t feel comfortable with. Keep in mind that some insurance companies refuse to cover the riskier surgical procedures that are known to cause expensive long-term problems. Of course, some of the riskier procedures are also among the most effective, but there are plenty of procedures that come with minimal risks and low costs. For example, the sleeve gastrectomy and laparoscopic adjustable-gastric-banding surgeries are two of the most common and safest types of bariatric surgery. While most insurance companies will be more than happy to cover these procedures if you meet their requirements, most will also try to avoid covering a riskier surgery, such as the biliopancreatic diversion.
Find Out What Your Insurance Covers
In some cases, your insurance company will refuse to pay for the entire procedure. Depending on your coverage and how long you have been with your insurance company, you may not be able to get full financing without the assistance of a lawyer. A lawyer who understands bariatric surgery insurance laws may be able to solve your problem alongside your doctor. Attempting to convince your insurance company to pay for the entire procedure when they have already refused is not an easy task if you’re doing it on your own. Remember that most insurance companies do require a copay on any medical procedure, even if it’s an expensive one that is difficult for the average person to afford. In preparation for the significant copay your insurance company will likely require, consider a financing program or a healthcare credit card that will let you make payments on it.
Talk to Your Surgeon’s Financial Aid Counselors
Some surgeons offer financial assistance to patients who are otherwise unable to afford a procedure. While getting full bariatric surgery financing from the surgeon’s office is not usually a possibility if you don’t have insurance, most surgeons have some type of plan available to help you pay for your procedure. Depending on your surgeon and your credit rating, it might be possible to go on a payment plan to help you get insurance and financing. You may also be able to obtain a healthcare credit card. Some credit card companies offer extensive healthcare credit cards to approved cardholders. You may also be able to save some money through the financial aid department at the hospital, but it’s unlikely the hospital will be willing to offer financing on anything other than the anesthesia.
Consider Getting Surgery at a Medical School
If your weight loss surgery insurance coverage is too low, you might want to consider letting your surgeon operate on you at a teaching university. Your surgeon will be the one performing and overseeing the operation, but medical students will be assisting your surgeon and watching the procedure, so they can learn from it. Many people feel self-conscious or nervous about getting surgery at a university, so most universities offer bariatric surgery financing to patients who are willing to let medical students learn from the procedure. It might seem dangerous to have a complicated procedure performed at a university, but every surgeon trained in this way. Getting surgery at a university is a very controlled, safe process, even though the idea is uncomfortable for many people.
Getting Approval from Your Insurance Company
Meeting your insurance company’s requirements for bariatric surgery approval will likely be the most difficult part of the journey. Most insurance companies are in favor of weight-loss surgery in general, but that doesn’t mean they think everyone needs it. If you have a note from your doctor stating that you cannot lose a significant amount of weight in a reasonable amount of time without bariatric surgery, your weight loss surgery insurance company will start making you jump through hoops to earn approval for your procedure. Requirements may include having a BMI of forty or higher, suffering from severe obesity for a specific amount of time, and finishing strict dietary programs. In almost all cases, insurance companies require that all surgery candidates undergo a physician-supervised diet program prior to earning approval for bariatric surgery financing.
Completing a Physician-Supervised Diet Program
The majority of weight loss surgery insurance companies have strict requirements for potential bariatric surgery candidates who are seeking coverage for their procedures. Completing a physician-supervised diet program is one of the most difficult requirements you will likely have to meet. Even if you have an extensive history with other reputable diet programs, your insurance company will still want you to complete a special diet program under the supervision of your physician. These programs are designed to make sure you can commit to a significant lifestyle change as opposed to trying to find out if you need bariatric surgery or not. If you can demonstrate you have the willpower to make difficult health choices, your insurance company is likely to approve your request for coverage. In most cases, physician-supervised diet programs last about six months, and you will need to meet with your surgeon once per month to discuss your goals and measure your progress.
What to Do if You Get Denied
If your weight loss surgery insurance company refuses to cover your weight-loss surgery even after you’ve met all its requirements, try not to panic. You can always appeal its decision to deny you coverage. First, get a copy of your policy. Look through it to make sure there were no misunderstandings, and that your policy does cover weight-loss surgery. Then write a professional letter to the representative of your insurance company. In your letter, list the reasons why your appeal should be approved, and request a thorough explanation detailing why the company denied your request. Request a written letter explaining why your coverage was denied as well. Include a copy of the letter from your doctor that states you need weight-loss surgery. If you maintain a professional attitude, your insurance company will likely approve your appeal.
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