Does Fidelis Medicaid Cover Bariatric Surgery Patients frequently search for “does Fidelis Medicaid cover bariatric surgery?” is indicating authorization criteria. Bariatric surgery is not possible without insurance company approval or permits. All insurance companies set criteria for non-emergency, on-demand surgeries. Every insurance company has similar evaluation criteria. There are some minor additions between companies. Fidelis Medicaid insurance company requires pre-approval for Bariatric Surgery. Patients who do not meet the pre-approval requirement will not be paid.

For Bariatric Surgery pre-approval, you must first prove the reasons for eligibility and necessity for surgery. Insurance companies only pay emergency surgery fees without prior authorization. For authorization, it is necessary to be examined in health institutions with which the insurance company has an agreement. For bariatric surgery, you need to take a number of tests after making a doctor’s appointment from hospitals that have a Fidelis Care agreement. It’s not easy to say yes or no to “does Fidelis Medicaid cover bariatric surgery?”

Bariatric surgery pre-authorization process is generally long and difficult. For bariatric surgery, you have to prove that you have not been successful even though you have been trying to lose weight for years and have tried many weight loss methods. You should get all doctor evaluation reports from hospitals that have contracted with Fidelis Medicaid insurance company. Otherwise, your reports are invalid for Fidelis Medicaid covered bariatric surgery. When you talk to the gastroenterology department about obesity, the doctor will review you for a compliance report.

Does Fidelis Medicaid Require Approval for Weigh Loss?

Patients with authorization, the answer is yes to “does Fidelis Medicaid cover bariatric surgery?”. Fidelis Medicaid requires approval for bariatric surgery. To get insurance company approve for weight loss surgery, you need to prove that you have experienced the harmful effects of obesity in the doctor’s evaluation reports. For this, Fidelis Medicaid doctors subject patients to tests in many aspects. Your health status is evaluated with Hemogram and function blood tests.

Doctors write a report confirming that surgery is mandatory and that you really need Bariatric surgery. You must forward your application for payment made with this report to the insurance company. You should apply for weight loss surgery authorization by telephone or face-to-face meeting on the subject. After the application, the insurance company doctors and specialists evaluate the declaration and doctor’s reports that you have submitted. If there are missing documents in the weight loss surgery application, you need to complete them. The answer to the“does Fidelis Medicaid cover bariatric surgery?” is yes, If there is no deficiency in your application. You will get your payment of the weight loss surgery costs or via the hospital from the insurance fee.

Which Bariatric Surgery Covered By Fidelis Medicaid?

Insurance policy approval indicates the exact answer for “does Fidelis Medicaid cover bariatric surgery”. The patient insurance policy type is changing the evaluation criteria for bariatric surgery. If you do not have a full coverage private insurance policy, you have to pay part of the surgery costs. In your insurance policy, you must clearly check the payment items related to the surgery costs.

There are 4 basic surgeries for bariatric surgery Fidelis Medicaid does not cover the surgery you want. Whichever surgery the bariatric doctor deems appropriate for you in the evaluation report, your insurance company opens a budget for that surgery. For this reason, you can ask the doctor to include them in the evaluation report by stating your wishes while meeting with the doctor. However, the bariatric operation type decision belongs only to the doctor.

Some types of bariatric surgery are much more expensive and if your insurance company is going to make partial payments, you should plan your budget. If 60% of the surgery costs are covered in your insurance policy, it means that 40% of the surgery fee belongs to you. So, this shows that you need a budget of 12 thousand dollars for a weight loss surgery of 30,000 dollars. So, we may say partially yes to “does Fidelis Medicaid cover bariatric surgery”.

Budget for weight loss surgery is not only necessary for the surgery period. Post-operative treatments are also extremely costly and versatile. There are also the costs of psychotherapy sessions, exercise, obstetrician or dietitian. For these, it is very important to review your insurance policy. Since, the expenses after weight loss surgery are extremely important for the success of the treatment. If you can’t do your budget planning correctly, you will have to have a revision surgery.

Why Fidelis Medicaid Does Not Cover Bariatric Surgery?

No, to “does Fidelis Medicaid cover bariatric surgery” is so frustrating, certainly. To clarify, there are many reasons why my insurance company excluded my weight loss surgery. In short, it is extremely upsetting to not be able to get my authorization for weight loss surgery. However, it is not the end of everything; you have the chance to apply again with appropriate evaluation. Certainly, Fidelis Medicaid does not authorize because:

  • Your body mass index is below the BMI 40,
  • Obesity did not cause a secondary disease,
  • The psychiatrist or psychologist proves that the report is not suitable for surgery,
  • Pregnancy, miscarriage or postpartum effects on your body,
  • There is a danger to your life in the operation.

If you have heart disease, high cholesterol or an auto-immune disease that carries the risk of death, you cannot undergo any surgery. To clarify, narcosis and bleeding factors are fatal even in simple surgeries . That’s why, Fidelis Care refuses weight loss surgery. Moreover, if doctors cannot see sufficient cognitive capacity or post-operative care, then she/he reports this to the insurance company. Whether you do not continue the treatments after the operation, you will face very negative difficulties or threats.

Above all, If you’ve had a baby recently or are breastfeeding, then your health isn’t exactly good. Therefore, you’re sharing most of your vitamins and time with your baby, and your body just doesn’t have the right blood values for another surgery. Additionally, one of the reasons why you can’t get authorization for bariatric surgery may be the expiration of the insurance policy date or the fact that you have not paid.  To conclude, when the insurance expires, the liability for treatment payment ends up.