Insurance Issues

 Why does it take so long to get insurance approval?

After you have completed all of the pre-operative tests and consultations and have meet with your bariatric surgeon, this information is then submitted into your insurance company. Your insurance company then reviews this information. This review process can very greatly but on average takes 2 to 4 weeks. Your bariatric surgeon’s insurance specialist can provide to you specific details about how long this process would take based on your specific insurance plan.  

•  How can they deny insurance payment for a life-threatening disease?

Approval for bariatric surgery may be denied because there may be a specific exclusion in your policy for obesity surgery or "treatment of obesity." Insurance approval  may also be denied for lack of "medical necessity." A therapy is deemed to be medically necessary when it is needed to treat a serious or life-threatening condition. Medical necessity denials may hinge on the insurance company's request for documentation of medical illness also known as a co-morbidity such as type II diabetes, hypertension, sleep apnea, or proof of being overweight for the past 5 years

•  What can I do to help the process?

Gather all the information (diet records, medical records, medical tests) your insurance company may require. This reduces the likelihood of a denial for failure to provide "necessary" information. Letters from your personal physician and consultants attesting to the "medical necessity" of treatment are particularly valuable. When several physicians report the same findings, it may confirm a medical necessity for surgery.

Work closely with the bariatric surgeon’s insurance specialist to ensure all required pre-operative tests and consultations are completed and on file. This will allow for a single submission of all required documents into your insurance company all at one time by the surgeon’s insurance specialist on your behalf as this helps to prevent any delays.