Paying for Weight Loss Surgery
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.
You can write a letter of appeal to the insurance company representative (such as a claims supervisor) who signed the denial. Before you appeal, make sure you understand your policy completely, and that it does not specifically exclude the weight loss surgery you want.
Also, make sure restrictions were not in place when you first began your contract with the health plan.
Your appeal letter should include:
- An explanation why you feel the procedure should be covered
- A request for a full explanation of why coverage is being denied (or paid at a reduced level)
- A request for a copy of the specific statement -- taken from the policy or benefits booklet -- that explains why your coverage is limited or denied
- A copy of the denial notification
- A copy of your doctor's preauthorization letter
You may find it helpful to send a copy of your appeal letter to your state's insurance commissioner or the department of corporations if you are covered by an HMO plan. You can explain that you’re having trouble, and ask for assistance. Your bariatric surgeon can help you with your appeal.
Other Ways to Pay for Weight Loss Surgery
If you do not have health insurance, or if your insurer will not cover weight loss surgery, talk to your doctor and your surgeon about financing plans. Check on the interest rate, and make sure you are OK with all of the terms.