Gastric
Bypass
Surgery
is a
covered
by many
insurance
companies.
Coverage
depends
on what
type of
policy
you have
and the
terms
within
the
policy.
Each
insurance
policy
can vary
greatly,
even if
different
policies
are
issued
by the
same
company.
Some
patients
choose
to pay
for the
Gastric
Bypass
procedure
on a
self-
pay
basis.
This
type of
arrangement
can be
made by
calling
Obesity
Surgery
Specialists
and
speaking
directly
with our
insurance
coordinator.
There
are two
separate
fees
that you
will
need to
consider,
one is
for the
surgeon
and the
other is
for the
hospital
at which
you
stay.
Gastric
Bypass
surgery
usually
requires
2-3 days
in the
hospital
and 2-6
weeks
for
recovery,
depending
on your
type of
work.
Will my
insurance
pay for
my
surgery?
Insurance
coverage
for the
Gastric
Bypass
procedure
depends
on a
determination
by your
primary
care
physician,
surgeon
or
specialist
that
gastric
bypass
surgery
is
medically
necessary
to
reduce
significant
medical
risks to
your
life.
Your
insurance
carrier
will
also
require:
-
A
thorough
medical
history
-
A
detailed
diet
history
over the
past two
consecutive
years
under
medical
supervision
-
Current height,
weight and BMI
(body mass
index)
-
A list of all
co-morbidities that
are or may be caused
by your morbid
obesity
-
A psychological
evaluation/clearance
-
Must be included in a
letter of medical
necessity written by your
primary care physician
and provided to the
Obesity Surgery
Specialists for
submission to your
insurance company.
What if
my
insurance
denies
my
claim?
If your
insurance
denies
coverage
for the
gastric
bypass
surgery,
don't
give up
hope. In
many
cases,
providing
additional
information
in the
form of
an
appeal
letter
could
result
in your
denial
being
overturned.
If your
insurance
carrier
continues
to deny
coverage,
you may
consider
seeking
legal
assistance.
Insurance
companies
will
often
relent
to avoid
confrontation.
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Additional
Information
regarding
insurance
coverage
for
gastric
bypass
surgery
Most insurance
companies follow the
recommendations of
the National
Institute for Health
when they set up
their guidelines to
qualify for surgery.
However, some
insurance companies
have offered an
“exclusion” to
employers when
contracting for an
insurance policy.
This means that your
employer may have
elected to not cover
the medical
treatment for
obesity or morbid
obesity.
Some insurance
companies will
require
documentation of a
history of morbid
obesity. You
can easily obtain
these records from
any physician you
have seen in the
past.
This
includes
your
primary
care
physician,
internal
medicine
physician,
gynecologist,
pediatrician,
or any
other
physician
who has
kept
track of
your
weight.
Insurance companies
will not accept a
summary letter from
your physician…they
will need the actual
office visit
records.
If you have taken
any medications that
were prescribed by a
physician to assist
in weight loss, the
insurance company
will want to see
these records.
Records
from
Weight
Watchers,
Jenny
Craig or
other
diet
programs
are
generally
not
accepted
for
documentation
of
attempted
weight
loss,
but if
you can
get
these
records
they may
be
helpful
as
supporting
documentation.
"...lack
of documented history is the
number one reason for surgery
denial"
Some
insurance companies will
require pre-operative
evaluation and clearance for
members who have a history of
severe psychiatric
disturbances or who are
currently under the care of a
psychologist/psychiatrist or
who are on psychotropic
medications.
