After exploring the options of bariatric surgery, you will need to determine how to pay for the surgical procedure. For many people, the surgery is affordable because it is included in their health insurance coverage. For others, it is a medical treatment they pay out-of-pocket.
Your bariatric program will assist you in working with your health insurance provider and help you adhere to your policy’s requirements.
Here are some key steps for obtaining insurance coverage for bariatric surgery:
Keep ongoing documentation of:
- Previous weight loss attempts including medically supervised diets, weight loss programs, and gym memberships
- Co-morbid conditions
- Current medications
- Visits to healthcare professionals for obesity-related issues
- How morbid obesity affects the quality of your life
Ask your bariatric surgeon for a letter stating the "medical necessity" of the surgery.
Increase your chances of obtaining approval for insurance coverage by working with your bariatric surgeon, your bariatric program, and your insurance provider. Provide them with as much information, including documentation such as receipts and medical records, as you can.
Read more about the Bariatric Surgery Approval and Financing Process .
Understand Your Certificate of Coverage:
While every health insurance policy is unique, it is important to understand your Certificate of Coverage. Read your insurance policy in detail, including what it covers and what it excludes. If your insurance company denies your request for bariatric surgery, you may be able to appeal the decision.
Appealing a Denial
If the insurance company turns down your request for bariatric surgery, you may be able to appeal the decision. Many people do not take advantage of the appeals process or know of the laws that govern insurance companies in their state.
Work with Your Bariatric Program
Assistance is key. It is critical that you work with your bariatric program to determine the correct approach to appealing a denial. Your program is there to assist you and to help you adhere to your policy’s requirements.
Tip
Write a description of how morbid obesity decreases the quality of your life. Be sure to include details such as difficulty walking, socializing, or maintaining personal hygiene. This documentation can be useful for your bariatric program and health insurance company.
Possible Options After Appeals Even if you exhaust the appeals options, you still may have options:
- Independent review board: This is an option available to people in more than 40 states and doesn’t require a lawyer. Judgments usually are issued in 60 days. Check your state’s website for specific filing instructions.
- Arbitration: Some health insurance companies require patients to use a third party—other than the patient’s lawyer and the insurance company—instead of going to court.
- Litigation: This option is expensive and takes a lot of time.
For more assistance, find a bariatric surgeon and program using the Surgeon Locator.
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