Verifying your Insurance Coverage for Bariatric Surgery
Verifying your Insurance coverage for Bariatric Surgery
What are some ways that you can help yourself get authorization for weight loss surgery? So that you are as informed as possible before you come for your first consultation with the bariatric surgeon, contact your insurance and make sure you have coverage for weight loss surgery.
How do I do this, you ask? Look at your insurance card. Usually on the back you will find a phone number for patients to call. Call and ask this question, “Do I have coverage in my policy for weight loss surgery?”
When doing this, it will make the entire process a little easier. The last thing that we want is for you to complete other requirements that might take your time and resources only to find out that you do not have insurance coverage to approve your surgery.
If you have coverage for weight loss surgery, be sure to ask your insurance company what their criteria or requirements are for them to approve your surgery. Each policy is different and remember, we do not send information into insurance company until ALL items required are completed. This gives you the best chance of an approval the first time we submit.
Here are a few items that will be needed:
• a consultation with the surgeon performing the surgery
• a clearance letter from the patient’s primary care physician (PCP)
• a psychiatric evaluation
Depending on the patients’ medical history and insurance requirements, more items may be required. Most insurance companies require a medically supervised diet. Depending on the insurance company, the dieting criteria vary from 3 consecutive months all the way up to 7 consecutive months. Some insurance companies stipulate that the diet must be done with the patient’s primary care physician. Insurance companies can also vary on the procedures that are covered. Some insurance companies may not pay for a certain type of surgery at all while other insurance companies may base whether or not they cover a particular surgery type on the patient’s body mass index (which is a measurement of weight in relation to height).
The more you know about your coverage and insurance requirements, the easier it will be for you to navigate the process. We have two pre-determination coordinators here in our office to assist you in getting approved for surgery. We are here to guide you and encourage you as you begin your weight loss journey.
The Pre-determination Coordinators