Does Your Insurance Company Cover Weight Loss Surgery Cost?

 

Weight loss surgery can resolve at least 30 weight-related health conditions. This is according to the American Society for Metabolic & Bariatric Surgery. This is also good news because it will encourage most insurance companies to cover the cost of weight loss surgery.

Don’t celebrate yet. Aside from the words “insurance companies,” please note the word “most”. Not all can guarantee 100% smooth processing and approval. Insurance companies, too, often ask for a few proofs of necessity, such as:

• A six-month Physician Supervised Diet Program (not all insurance companies need this)
• A psychological evaluation
• A nutritional evaluation
• Recent diagnostic tests
• Five-year weight history documentation (including information on diet drugs taken)
• Records of gym membership or commercial diet programs you enrolled in the last five years

The Physician Supervised Diet Program

Medicare seldom requires the Physician Supervised Diet Program. But, it will help if you enroll anyway and provide your insurer a documentation of your progress.

This six-month process includes a consistent monthly consultation. Both you and your surgeon will set goals and make sure you achieve them through a set of diet and exercise regimens.

The insurer wants all information that will guarantee your commitment to a lifetime of healthy habits. Otherwise, it will mean paying for a load of hospitalization, and even re-surgery in the future.

Completing the six-month program only gives you a higher chance of getting approved for weight loss surgery. It does not seal the deal.

The psychological evaluation helps the insurance company to determine your mental fitness. They need to know if a patient is mentally sound to accept the changes that will happen after the weight loss surgery. The patient’s mental health will help predict possible eating disorders and other psychological issues. These may hamper the surgery’s success.

The nutritional evaluation on also gives them an idea on the dietary changes after the weight loss surgery.

Diagnostic tests

Most insurance companies oblige patients to submit diagnostic test when reviewing the documentation. Usually, the surgeon submits the said documentation to the insurance company after completion of the program.

The diagnostic tests include:

• Cardiac and pulmonary evaluation
• Evaluation for sleep apnea
• A1c test

These guys want to be all-out certain about where their money goes. It’s their nature. They may approve your request or turn it down despite all your efforts. They may also agree to pay only a small percentage of the total cost of the weight loss surgery.

If it comes to that, you can still make an appeal. Find out the reason behind the denial. Look for that reason. Make sure you have absolute understanding of your policy’s terms and conditions.

Your bariatric program will help you deal with insurance companies.

Weight loss surgery cost

The typical cost of weight loss surgeries plays around $20,000 to $35,000. It may cost more depending on the following:

• The type of surgery you intend to undergo
• The hospital of your choice
• The surgeon’s fee
• Location
• Hospital room fee
• Lab fees
• Operating room fee
• Anesthesiologist fee
• Consultation fee
• Device fees

Some people do not have issues paying straight from their pockets for their gastric bypass surgery. But, most of them may expect their insurance companies cover health expenses for possible complications. Some cannot afford the surgery and post-op expenses. Good thing that alternative financing programs apply to make the gastric bypass operation happen.

For example, medical and/or home equity loans. If your insurance does not cover weight loss surgery cost, your bariatric surgery team can offer you these options. But, you must consider that bigger things are at stake with these types of loans.

A few more tips

Now that the medical community acknowledges weight loss surgery as more than just a vanity thing, you should consider going through the process if natural weight loss methods never worked for you in the past. Trying out various weight loss pills and diet plans only waste your time and money.

Take time to ponder and decide if weight loss surgery is the right way to go. And in case you have decided already, you better make sure that all your financial support  are already in place.