The first doubt that most people have regarding the financial aspect of Bariatric surgery is whether or not it is covered by insurance.
Well, most of the time, the answer is yes. Especially in cases where bariatric surgery is medically prescribed.
Once you have discussed your options with your physician and you both agree that bariatric surgery is required for you, the first thing you will have to do is speak to the insurance specialist at the clinic where you will undergo the procedure.
The insurance specialist will ask you to give him a copy of your insurance card. Your surgeon will need to write a “letter of necessity” to your insurance company, clearly stating all the reasons your surgery is medically required.
Before this letter is submitted to your insurer, you will have lab tests to ensure that you do not stand any health risk because of the procedure. The letter is then forwarded to the insurance company along with the lab results for “pre-authorization.”
This process of pre-approval may sometimes takes quite a few days, weeks, and in some cases, months.
Here’s what you need to know in case the insurance company refuses to pay.
In case your insurance company denies pre-authorization, you will still have several options.
The first step is to appeal the denial.
If your appeal is still not granted, you can request an outside reviewer to help you with your request.
If all else fails, there are few legal firms whose specialty is to help patients get approval for weight loss surgery. Also, some patients switch their insurance to some other company.
Fortunately, the appeals process is rarely needed. Every insurance company is different, but most of them eventually approve bariatric surgery. Immediately after your surgery is pre-authorized, your appointment with the surgeon can be fixed.