Does Simply Healthcare Cover Weightloss Surgery?
Does Simply Healthcare Cover Weightloss Surgery? Many people want to know if Medicaid in Florida covers bariatric surgery. First of all, it would be better to give some general information.
Let’s talk about insurance coverage for bariatric surgery. Bariatric procedures are usually covered by health insurance. But for bariatric surgeries, this coverage depends on whether or not the health plan has a bariatric surgery benefit.
You should check your health insurance plan to see if it covers bariatric surgery. It will also vary how much of the hospital and doctor’s bill you will have to pay.
How Does Simply Healthcare Cover Weightloss Surgery?
Each insurance company has its own written policy and requirements for bariatric surgery, but here are some of the most common ones:
- Your own doctor should write a Medical Requirement Letter. You must have had a Nutritional Consult or nutrition counseling once a month for up to 9 months.
- A psychological assessment
- You must have been on a medical diet program for at least two years with the help of a specialist. But this plan must not have worked.
- You have to get medical approval 30 days before the surgery.
Obamacare’s rules for weight loss surgery apply to all individual, family, and Small Group plans. But you must have bariatric surgery in a state where it is considered “primary health care.” Basic Health Benefits are set by lawmakers in each state based on what an average health insurance plan covers.
In Florida, on the other hand, Obamacare does not require insurance companies to cover weight loss surgeries. So, if you live in Florida and have health insurance through the Affordable Care Act, you will not be able to get bariatric surgery.
What Should You To Get Simply Healthcare Cover Weightloss Surgery In Every State?
Most flat Medicaid plans in the state of Florida do not cover bariatric surgery, which is a shame. But if you have a Humana Medicaid plan or a United Medicaid plan, your bariatric surgery will be covered as long as you meet the requirements. But Medicaid insurance in Florida covers tests and treatments for digestive disorders, as well as services for the stomach and intestines. Here is a list of the services for the GI system:
- Services for digestive surgery, such as:
- A surgery in which the size of the stomach is changed and the stomach is shrunk.
- Malabsorbtive bariatric surgeries, in which doctors change the digestive system completely and change absorption.
- Surgery in which doctors change both digestion and absorption by using a combination of the two
- Revisions of bariatric surgery, which means feedback about problems with the surgery
- How the stomach works
Who Can Have Simply Healthcare Coverage For Weightloss Surgery
In short, it can be used for services that your doctor says are medically necessary for your stomach. If your Medicaid insurance covers bariatric surgery, you must meet certain requirements. These things:
- You have to be 18 or older.
- A doctor should tell you that you are morbidly obese.
- So the Body Mass Index (BMI) must be over 40.
- Or you must have a BMI between 35 and 39.9 and have one of the following: severe sleep apnea, Pickwick syndrome, cardiomyopathy, or type II diabetes.
Here are the ways you can get your insurance to cover bariatric surgery for Individual Plans and Family Plans:
Even if you decide not to go through with the surgery, your surgeon can check for free to see if your insurance will cover it by calling your insurance company. Surgeons know how to get approval from insurance companies, so you can put your trust in them. Yes, you can call your insurance company on your own. And you should look at your plan’s summary.
There are three ways for Health Plans Through Your Work to give insurance coverage for bariatric surgery: First, your doctor can call your insurance company on your behalf. Also, giving up on surgery in the middle of the process doesn’t change anything. Your own doctor has a lot of say over how your insurance company approves things.
Second, you can talk to your company’s Human Resources department about this problem. You can always call your insurance company yourself, which is always a valid option. And make sure you have a Summary Plan Statement.
Medicare Coverage For Weight Loss
Bariatric surgery is covered by Medicare and Medicaid as long as you follow the rules below.
- Your BMI should be over 35.
- Obesity must be causing at least one health problem.
- Records of treatments that didn’t work
The Centers for Medicare and Medicaid Services should also list your doctor (CMS). Because Medicaid pays surgeons so little, almost all of them don’t take it. Because the money they get from Medicaid is usually not enough to cover all of their costs.
So, if you have Medicaid insurance, you should check with your surgeon to see if he or she will take it. If he says no, you can ask him to recommend a surgeon who will take your insurance.
How To Get The Best Insurance Company For Weight Loss?
Let’s make a list of the transactions that are covered by insurance and the ones that aren’t. Most health plans that cover bariatric surgery will pay for sleeve gastrectomy, gastric bypass, gastric band (lap band) surgery, and duodenal replacement surgery. (If you meet the criteria for coverage, of course.)
Insurance companies usually don’t pay for gastric balloons, assistive devices, or experimental procedures. Assuming your insurance covers bariatric surgery, you must meet all of your insurance’s requirements to prove you need medical surgery. All of these steps can take anywhere from a month to a year to complete.
Lastly, you can contact your insurance to get more specific and detailed information about this process. Because insurance companies can keep a separate file for each customer and evaluate it based on that file. Don’t forget that your doctor and insurance company will always be ready to use the methods that help you the most. You can always change them if you don’t like them. Or, you can change your plan so that bariatric surgeries are covered.
With this article, we tried to answer your question. If you live in Florida and have Medicaid, you don’t have many options for bariatric surgeries and procedures.