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Can I Buy Insurance To Cover Bariatric Surgery?

Can I Buy Insurance To Cover Bariatric Surgery Let’s look for an answer to the question of whether can I buy insurance to cover bariatric surgery. Here’s what you need to know first:

Bariatric surgery insurance coverage varies depending on the insurance policy you have. If your policy includes weight loss surgery and you meet qualification requirements, most plans will pay you for gastric tube, gastric bypass, Lap-Band, or duodenal switch surgery.

Also depending on the policy you have, your insurance cost can be as little as $0. In addition you have to pay some of your costs in the form of copays, deductions and coins, according to most insurance plans.

 What you need to do before having weight loss surgery is to know if you have a special policy. After you should then start researching your insurance company’s specific coverage requirements.

Individual or Family Insurance: Insurances That Cover Bariatric Surgery

It became mandatory for all insurance companies in 23 states to cover weight loss surgery after the Affordable Care Act was enacted for Individual Plans, Family Plans, and Small Group Plans (employers with fewer than 50 full-time employees).

The Affordable Care Act applies in the following states: Arizona, California, Colorado, Delaware, Hawaii, Illinois, Iowa, Maine, Maryland, Massachusetts, Michigan, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Rhodes Island, South Dakota, Vermont, West Virginia, Wyoming.

Here are your options for getting your insurance approved to cover Bariatric surgery:
• Your own surgeon can confirm your coverage free of charge by contacting your insurance company, even if you are not going to proceed with surgery. Surgeons are familiar with insurance company approval processes, so you can trust them with confidence.
• Absolutely you can contact your insurance company yourself. And also should check your summary plan description.

For Employees: Insurances That Cover Bariatric Surgery

Small Groups (50 or fewer full-time employees)

Insurance coverage guidelines for bariatric surgery are the same as for individual or family insurance for Small Groups (50 or fewer full-time employees).

There are three options for approving bariatric surgery insurance coverage for the Small Group:

• (Recommended option): Firstly your doctor can contact to your insurance company for you.  Moreover it doesn’t change anything if you give up on surgery during the process. Your own surgeon has a great deal of control over insurance companies’ approval processes.

• Secondly you can apply to the Human Resources Department of the company you work for about this issue.

• Always valid option: you can contact your insurance company yourself. And also should check your Summary Plan Statement.

Large Groups (50+ full-time employees)

If you work in a workplace with more than 50 full-time employees and your company provides insurance, your company will decide whether your insurance will cover the cost of bariatric surgery.

In this case, there are three options to confirm your coverage:

• You have the option of contacting your insurance company through your doctor. And this option will be easier for you.

• Also you always have the option of consulting the Human Resources Department of the company you work with in large groups.

• And again you can directly contact with your own insurance company.

If you belong to the Large Group or Small Group and your employer has provided you with short-term disability insurance, you will be entitled to a portion of your salary during surgery and during recovery.

If You Are Covered by Medicare or Medicaid

Medicare and Medicaid will cover bariatric surgery as long as you meet the guidelines listed below.

1. Your body mass index should be over 35.
2. You must have at least one health problem caused by obesity.
3. In the medical records that the doctors have prepared for you, there should be information about the unsuccessful treatment methods used for obesity.

Also Medicare and Medicaid cover the following procedures if you meet all of the listed criteria:

Gastric sleeve surgery (laparoscopic only),
Gastric bypass surgery (open or laparoscopic),
Lap band surgery (laparoscopic only),
Biliopancreatic diversion (open or laparoscopic) with duodenal switch (BPD/DS).

In addition to be approved, the attending physician must refer you. Your surgeon should also be listed in The Centers for Medicare and Medicaid Services (CMS). The vast majority of surgeons do not accept Medicaid because of its low reimbursement rates. Because usually the payments provided by Medicaid are not enough to cover their costs.

Therefore, if you have Medicaid insurance, you should ask your surgeon if he or she will accept this insurance. If he does not agree, you can ask him to refer you to another surgeon who will accept your insurance.

So if you have Medicare Advantage, you must verify that the surgeon and hospital you choose are in your insurance company’s network. To find out, you can contact your insurance company directly.

Procedures Covered And Not Covered By Insurance Covering Bariatric Surgery

Most health plans that cover bariatric surgery insurance will agree to pay for gastric sleeve surgery, gastric bypass surgery, gastric band surgery (lap band surgery), duodenal switch surgery. (Of course, if you meet the coverage criteria)

Generally insurance companies will not cover are gastric balloon, aspire assist, experimental procedures.

Assuming your insurance plan covers bariatric surgery insurance, you must meet all of your insurance coverage criteria to confirm you need medical surgery.

The process, which includes all these processes, can take from a month to a year.

What it takes to prove that you need surgery

The requirements to prove to your insurance company that it is medically necessary to have the surgery are:

1. Your minimum body mass index
Must be over 40,

Or over 35 if you meet at least one of the following:

Clinically significant obstructive sleep apnea,

Coronary heart disease,

Medically resistant hypertension,

Type 2 diabetes.

2. And, depending on the insurance you have, you must complete a medical diet program that ranges from 3 to 7 months.

3. In addition you have to schedule a consultation with your surgeon.

4. After, you need to get a medical authorization letter (thanks to your primary care doctor).

5. In addition to these, they want you to get a permission letter from the psychiatry department regarding your mental health.

6. You should also go to a registered dietitian and have a nutrition plan made.

7. After, send all the documents and your medical history to your insurance company. The review process will take less than a month.

8. Subsequently, the Insurance company sends you a letter of approval or rejection.

• If your request is approve, your surgeon will contact you to schedule bariatric surgery.
• If your request is rejected, you have the right to object.

And thus we have answered the question ” Can I buy insurance to cover bariatric surgery?”