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Gastric Bypass Insurance Coverage

When someone starts to consider undergoing a gastric bypass surgery, one of the most important factors is the cost and whether or not their insurance company will cover the surgery. The good thing is that in many U.S. states, the insurance companies are required by law to provide insurance coverage to bariatric surgery as long as the patient can pass the minimum requirements which have been set by the National Institutes of Health. Regardless of this fact, the approval process by the insurance company is not regulated and you can expect that this time period will be long. Rather than paying out immediately for an elective procedure, the insurance companies want to make the approval process as long as possible hoping that you will either forget the procedure or move to another insurance company.

It is important to both read and understand your insurance company’s coverage certificate as it will assist in the approval process. Even if it does not need one, ask your family physician for a letter of referral. Since your family doctor is already approved by your insurance carrier they will more than likely listen to the referral by one of their physicians. You will also need to keep descriptions, log or diary as well as the receipts of your expenditures in your ongoing structured weight loss program as evidence that you are in one.

You will need to document every visit to a physician for a weight related issue. This documentation may also include the weight loss programs that you are currently attending or have attended in the past as well as various dieting centers and fitness clubs. Having all this information will help in the approval process.

After doing all of this, you will need to prove that you are morbidly obese with a body mass index of greater than 40 and will have been obese for a period of no less than 5 years prior to the scheduled bariatric surgery. You have to have attended a weight loss program for at least the last 6 months as well as have a medical issue as a result of you morbid obesity that can be cured by having the procedure done.

If all of this is in order then your chances of being approved will be far greater. Although you may still have to wait for the approval to go through.