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Getting Your Insurance to Pay for Weight Loss Surgery

Most major insurance companies will require:

  • Proof that surgery is medically necessary. Your surgeon can help provide your medical history and documentation of your weight-related health problems.
  • Participation in a physician-supervised diet program. You may be required to successfully complete a 6-month weight-loss program before approval is granted. Medicare does not require this 6-month program, but you may be encouraged to participate anyway. This type of diet program involves monthly visits to your doctor or bariatric surgeon's office for 6 months. The insurance companies aren’t trying to find out if you can lose weight through dieting. In fact, most insurance companies require that the patient's weight be stable during this time -- with no up-and-down fluctuations -- or you may be denied coverage. They want you to demonstrate over the 6 months prior to surgery that you can commit to lifestyle changes you’ll need to make forever after your weight loss surgery.
  • A psychological evaluation. This is to make sure that you understand weight loss surgery and the impact it will have on your lifestyle. The psychological evaluation also checks for untreated binge eating or any other psychological issues.
  • A nutritional evaluation. You will work one-on-one with a nutritionist to outline specific dietary changes and habits that need to be changed.

What Happens Next?

When you have completed these steps, the surgeon will send a preauthorization letter to your insurance company. The letter will outline your medical history and health problems related to your weight, and provide documentation that you have completed all requirements for approval.

The insurance company will then review your case. If you have symptoms of weight-related conditions, the company may request specific diagnostic tests, such as cardiac, pulmonary, or sleep apnea evaluations.

During this period, keep accurate notes of all communications between the insurance company and your surgeon. Keep copies of completed insurance forms, letters sent, and letters received.

What if Your Insurance Company Declines Coverage?

If your request is turned down, or if the insurance company agrees to pay only a small percentage of the cost, the door is not closed.

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