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Will Insurance Pay For Weight Loss Surgery?

Apr 5, 2008
If you are considering weight-loss surgery, you have probably spent some time wondering if your insurance will cover the procedure. Generally speaking, most insurance companies have come to understand the importance of fighting obesity. Though your insurance provider will need to ensure that you qualify for weight-loss surgery, your chances of securing coverage have improved dramatically in recent years. Even if you do not have insurance or qualify for coverage, NewHope Bariatrics has a number of options to make both the LAP-BANDŽ procedure and long-term weight loss an exciting - and affordable - reality.

Conditions for Coverage

When trying to determine if your insurance provider will cover weight-loss surgery, you should first refer to the information package you received when your policy coverage began. In most cases, the benefits of your insurance policy will be listed clearly under a title such as "covered expenses." If you do not have access to your insurance policy, you can simply call the customer service phone number listed on your insurance card and ask the representative if bariatric surgery is covered, and if so, what the requirements for coverage are. Please note that while and insurance companies may have plans that offer bariatric surgery coverage, often, the employer chooses whether to offer bariatric coverage as part of its specific policy. So, if your insurance is through an employer, please verify that your specific policy covers surgery for obesity. If it seems that weight-loss or bariatric surgery is not covered by your policy, pay close attention to the fine print and try to determine if there are any exceptions - such as secondary health concerns - that may qualify you for coverage.

Before your insurance provider will approve you for coverage, they will need to verify that you meet the requirements to pursue weight-loss surgery. For your insurance provider to determine that the procedure is medically necessary, you will need to submit detailed information about both your health and previous failed efforts to lose weight. Much of this information can be provided in a document known as a Letter of Medical Necessity. NewHope Bariatric physicians are very familiar with the requirements of insurance companies in determining coverage for weight-loss surgery. We will supply your insurance company with appropriate documentation and records. In this letter, the following information is usually included:

* Why weight-loss surgery is medically necessary - This section covers information about how obesity directly impacts your overall health or documentation of secondary health conditions that have been impacted by your weight to demonstrate that weight-loss surgery is the most effective treatment.

* Number of years you have been overweight - In nearly all cases, insurance providers and weight-loss surgeons will look for patients that have been overweight for at least five years.

* Body weight or body mass index (BMI) - Candidates for weight-loss surgery should be at least 100 pounds over ideal body weight, or have a BMI of at least 40. In some cases, patients with a BMI of 35 who have at least one health condition related to obesity can be candidates for weight-loss surgery.

* Obesity-related medical problems - It is important to document the presence of conditions such as type 2 diabetes, sleep apnea or hypertension as secondary medical concerns. This can help your insurance provider recognize the importance of your weight-loss surgery procedure.

* Failed weight-loss efforts - It is important that you provide as much information as possible about all failed weight loss attempts. This documentation should include an outline of your diet and exercise efforts as demonstration of your longstanding commitment to weight loss, regardless of the results. Whether the information provided comes from your own records, a commercial weight loss program or previous medical supervision, the more documentation you provide attesting to your efforts to lose weight, the greater chance you have of receiving approval from your insurance provider.

In addition to the information outlined above, you may also need to receive psychological, nutritional and/or other similar evaluations. When communicating with your insurance provider, you should also try to be very specific in describing your condition. As obesity and morbid obesity are classified as two distinct medical conditions, you want to make sure that your insurance provider understands your correct obesity classification when evaluating your claim.

How NewHope Bariatrics Can Help

As the requirements for insurance coverage can often be difficult to understand, NewHope Bariatrics is committed to help patients navigate the process. Having worked directly with numerous insurance providers, NewHope Bariatrics can assist patients in completing the necessary paperwork and assisting with the insurance authorization process. NewHope Bariatrics can also help patients determine the amount of available coverage, highlight any possible contractual agreements between NewHope Bariatrics and the insurance provider and help estimate any out-of-pocket costs. NewHope Bariatrics and our physicians will provide support in working with you and your insurance company throughout the authorization process.

If you don't have insurance or your plan doesn't cover the LAP-BANDŽ System, NewHope Bariatrics can also work with you to find an affordable financing program. There are several payment packages and discount opportunities available and prospective patients can take advantage of free referrals to a number of trusted lenders who are familiar with helping weight-loss surgery patients.

Whether your insurance covers the LAP-BANDŽ procedure or not, you will also have an opportunity to see a unique cost comparison during your financial consultation. Most people don't think they can afford to pay for LAP-BANDŽ surgery, but what many people don't realize is that they can hardly afford not to. The costs of living with obesity can exceed $15,000 annually! The LAP-BANDŽ procedure can practically pay for itself within one year. Additionally, patients without adequate insurance coverage can also take advantage of potential tax deductions, bringing the total cost down even further.

As the LAP-BANDŽ is regarded as both the most affordable and lowest risk weight-loss surgery, the benefits of the procedure far outweigh the costs for most patients. Though your chances of receiving insurance approval will be contingent on the requirements of your provider, there are many funding options available to prospective patients. As obesity takes such a great toll on life - both physically and financially - the LAP-BANDŽ procedure can represent an incredible opportunity for all qualified individuals.
About the Author
Carole S. Guinane, a Chief Clinical Officer writes articles about obesity and weight loss for New Hope Today.
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