Paying For Weight-Loss Surgery: Insurance - My Bariatric Life

My Bariatric Life Health Guide
  • Gastric bypass surgery costs between $18,000 and $22,000. Adjustable gastric banding costs between $17,000 and $30,000.

    • The surgeon will want to be paid.
    • The anesthesiologist will want to be paid.
    • The hospital where the surgery is performed will want to be paid.
    • The dietician and the nutritionist will want to be paid.
    • Then there are the physical trainers and the behaviorists. They too will want to be compensated.

    It all adds up...and up...and up. Right about now, you might be asking yourself "How am I supposed to pay for all of this." Good question. The answer could very well be "I can't."

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    Health Insurance and "No" For an Answer

    Some people have health insurance, others do not. Having insurance does not mean that weight-loss surgery will be covered by your policy. About one quarter of people seeking weight-loss surgery will be denied three times by health insurance companies before they are approved. Rejection by insurance carriers and prerequisites that cannot be met are the main reasons why people do not get a weight-loss procedure. Oddly enough, insurance companies will readily address the barrage of health deficiencies caused by obesity and all the expenditures that accompany them. If you are denied, appeal the decision.

    Insurance Criteria for Weight-Loss Surgery

    In order for those insurance companies who do cover weight-loss surgery to approve the procedure, the surgery must be deemed medically necessary. Different insurance companies have different criteria for defining medical necessity. Examples of qualifying criteria might be having the condition of morbid obesity for two years or more, a body mass index greater than 35 along with heart disease or type 2 diabetes or severe sleep apnea or severe hypertension.

     

    But wait, there's more. The patient must also have had a history of failed attempts at weight loss and participated in a program of nutrition and exercise that had been overseen by a physician.

    A Little Help From Your Friends

     


    Most insurance companies will want a letter of medical necessity from your surgeon or primary care doctor. The letter must include your height, weight, and BMI. A history of your obesity related health conditions will be needed, as well as a list of your current medications, a report about how obesity effects your daily living, and a history of dieting attempts and programs of exercise.

    Do not be disheartened by such stiff criteria. It is the protocol for getting the nod from an insurance company for weight-loss surgery. Many have had success, and there will be many more. Proceed with determination.

    Medicare

    Medicare is the government health plan for people who are sixty-five years old or more. It fairly recently agreed to finance three types of weight-loss surgery provided the procedure is done at a facility that is recognized as a Center of Excellence by the American Society for Metabolic and Bariatric Surgery or a Level 1 Bariatric Surgery Center. Before Medicare approves the surgery they normally require patients to engage in a six-month long weight-loss program supervised through their surgeon or primary physician.

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    Approval for weight loss surgery is not automatic, but reviewed on a patient by patient basis. You can learn all about Medicare coverage for weight loss surgery from the Medicare National Coverage Determinations Manual.

     

    Up next: Paying For Weight Loss Surgery: Medical Travel, Medical Tourism

     

     

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    My Story...

    You can read about my decision to have weight loss surgery back in 2003 and my journey to maintain a lifetime of obesity disease management since that time. My wish is to help you on your own journey of lifetime obesity disease management with shareposts along the way to help you navigate that journey successfully.

     

     

Published On: March 15, 2012