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Financing Weight Loss Surgery

Getting Your Insurance to Pay for Weight Loss Surgery continued...

In the last few years, insurance companies have also begun requiring patients to participate in a six-month Physician Supervised Diet Program before they will grant approval (Medicare does not require this six-month program, but Medicare patients are often encouraged to participate anyway).

Even if you have dieted for 10 years with Weight Watchers or under a doctor's supervision in another weight loss program, you must complete a Physician Supervised Diet Program. The insurance companies aren’t trying to find out if you can lose weight through dieting. They want you to demonstrate over the six months prior to surgery that you can commit to lifestyle changes you’ll need to make forever after your weight loss surgery.

A Physician Supervised Diet Program involves monthly visits to your bariatric surgeon's office for six consecutive months. Together, you and your surgeon will set exercise, diet, and lifestyle goals, and you will start a regimen to meet those goals. 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.

For many people, keeping their weight stable is the biggest challenge. But it's worth the effort. Most insurance companies will approve weight loss surgery for people who successfully complete this six-month program.

Most major insurance companies also require:

  • A psychological evaluation to make sure the patient has a clear understanding of weight loss surgery and the impact it will have on one’s lifestyle. The psychological evaluation also checks for untreated binge eating or any other psychological issues.
  • A nutritional evaluation -- working one-on-one with a nutritionist -- to outline specific dietary changes and make suggestions on specific habits that need to be changed.

 

Getting Insurance to Cover Weight Loss Surgery: The Next Steps

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

The insurance company will then review your case. If there are symptoms of obesity-related disorders, 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.

If Your Insurance Company Declines to Cover Weight Loss Surgery

If your request is turned down -- or if the insurance company agrees to pay only a small percentage of the cost of weight loss surgery -- you can appeal the decision. When you're determined to get your insurance to cover weight loss surgery, the door is not closed.

Before you appeal, make sure you understand your policy completely. Make sure it does not specifically exclude the bariatric surgery you desire. Also, make sure any restrictions were not in place when you first began your contract with the health plan.

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