What do I Need to Know about Bariatric Surgery Insurance?

There are some key areas that you need to learn about and understand regarding bariatric surgery insurance before you even begin to plan your bariatric surgery. Detailed information throughout this website is available on bariatric surgery costs, health insurance requirements and the documentation needed to effectively manage your bariatric surgery insurance claims and out of pocket costs.

Bariatric Surgery Insurance Requirements

Eligibility requirements for bariatric surgery insurance coverage can vary widely depending on the policy. Most if not all insurance companies will require that you have a body mass index (BMI) of at least 40. Some plans will accept a BMI of 35 with supporting evidence of related conditions. The majority of policies also require a history of physician supervised diet as well as psychological, nutritional and psychiatric testing to determine if you are an appropriate candidate. Itís important to enlist the support of your physician and surgeon in meeting the requirements.

Bariatric Surgery Insurance Documentation

One of the most important methods for improving your chances for getting your bariatric surgery procedures approved is accurate and consistent documentation of your previous weight loss treatment. All bariatric surgery insurance requirements must be adequately documented. Coverage can be denied for insurance claims that are not adequately documented. Review all documents to ensure they support your case, forward copies to your surgeon to submit. Retain copies of all documentation for your records in case you need to provide proof of submission or resend any information.

Bariatric Surgery Costs

Bariatric surgery costs are complicated and can add up rapidly. The average cost of bariatric surgery can be from $17-$35,000 depending on procedures needed, recovery complications if any, and after care procedures and programs. Even for bariatric procedures that are covered by your health insurance plan, out of pocket costs can soar without careful attention to co-payments, annual deductibles and provider network requirements.

Bariatric Surgery Insurance Coverage

Bariatric surgery insurance coverage depends more on the policy than the insurance company. Medicare and Medicaid will often cover bariatric surgery procedures when patients meet obesity standards set by the National Institute of Health (NIH) and are treated at a qualifying surgery center. Larger self-funded employers are able to elect whether or not to provide bariatric surgery insurance coverage. Policies administered by private companies such as Aetna, Blue Cross, Medical Mutual and others usually have a more complex process and multiple denials are common.

Determining your Bariatric Surgery Insurance Coverage

A key thing you need to understand in order to determine your bariatric surgery insurance coverage is how each of the tests, procedures, post-procedures, after care programs and any resulting complications are addressed by your specific insurance policy. Information on covered and excluded benefits can be found in your policy information packet and then clarified by contacting your policy administrator directly to discuss any questions you may have about coverage. In many cases additional surgeries such as body sculpting, liposuction, and facial lifts will not be covered procedures.

It is your responsibility to take an active role in the bariatric surgery insurance process by knowing your benefit coverage details, staying up to date with changes in insurance claim requirements and submitting complete and accurate documentation.