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Does Insurance Cover Weight-loss Surgery for Morbid Obesity?
Most health insurance policies actively cover surgery for weight loss. The majority require a letter of medical necessity from the prescribing doctor which states that it is not simply for improving one’s looks but is definitely in need of medical attention. The bariatric center can provide a detailed letter to the medical insurance company which will by and large result in pre-certification of coverage. Some health insurance companies may try to deny you health insurance coverage despite the doctor’s recommendation. It is then your responsibility to contact the health insurance carrier and be more assertive in your appeal. The weight loss surgery clinic that you use can often help direct you in what needs to be done to be successful in obtaining health insurance coverage for your bariatric procedure..
Which insurance companies cover bariatric surgery?
You will want to obtain a copy of your current insurance policy to determine if these procedures are covered. It isn’t always to so easy to navigate the waters in terms of getting the coverage you need for weight loss surgery. That is why most bariatric centers will help you along the way to get the approval that you need. Work with them closely to get the approval you need. They have the experience and will generally know what companies do and don’t cover.
Some health insurance companies that cover weight loss surgery are:
- Blue Cross/Blue Shield (not in all states)
- First Health
- United Healthcare
- Aetna
- PHCS
How About Medicare?
In February 2006, Medicare started covering Adjustable Lap Band Surgery and Roux-en-Y Gastric Bypass (open or laparoscopic). In addition to meeting standard patient criteria, Medicare coverage only applies when the bariatric procedure is done in a hospital or by a medical practice that is awarded a “Center of Excellence” by the American College of Surgeons or the American Society for Bariatric Surgery. In general, if the procedure is performed by a Bariatric Center of Excellence team, Medicare normally pays for it as long as a patient falls within Medicare’s guidelines. Medicare requires patients to have a BMI of 35 or more with at least one considerable chronic health problem. Medicare has a coverage policy manual that you need to become familiar with, but your bariatric clinic staff will be very helpful if you need answers. It will not cover liposuction. Related Terms: Obesity Surgery, Gastric Bypass Surgery expensive, Bariatric Surgery, Bariatric Surgery Costs, Paying for Gastric Bypass Surgery
