25 August 2008

While the choice to undergo weight loss surgery is an important medical decision, for many, it is a significant financial decision as well. Because weight loss surgery can cost patients thousands of dollars, many insurance companies and financial lenders offer assistance to help make payment more manageable.

The Cost of Weight Loss Surgery
The cost of weight loss surgery varies from surgeon to surgeon. It can range from $15,000 to over $40,000, if the surgery is successful and there are no complications.. The process is typically initiated when you have your initial consultation with your surgeon.
The cost of surgery includes the following fees:
  • Hospital fees
  • Surgeon fees
  • Anesthesia fees
  • Lab and X-ray fees
  • Miscellaneous fees
If you are paying for weight loss surgery yourself, be aware that the surgeon’s fees are only a portion of the total cost. There are additional fees for blood tests, X-rays, anesthesia, nursing care, medications and many other types of care.

Convincing insurance companies that bariatric surgery is medically necessary is likely to be the biggest hurdle patients face. It is important that patients understand the insurance approval process and play an active role in pursuing coverage for the cost of bariatric surgery.

Bariatric Surgery and Insurance
In many states, there are laws in place that require insurance companies to provide benefits for weight loss surgery when a patient meets the National Institutes of Health (NIH) criteria. However, obesity surgery patients should still prepare themselves for what is commonly a long and complicated approval process. The best chance for obtaining insurance coverage for the cost of LAP-BAND and gastric bypass surgery comes from working diligently in cooperation with your bariatric surgeon and other experts.

The Insurance Approval Process
There several helpful things that you can do to smooth along the insurance approval process. Following the steps below may be able to increase your chances of being approved for obesity surgery coverage.

It is important that you read and understand your insurance company's "certificate of coverage." You can get it from your insurance company directly or from your employer's benefits contract.
  • Get an obesity surgery referral from your doctor. You must have your doctor's full support.
  • Save all of your receipts and always keep accurate, detailed records.
  • Carefully document each visit you make to doctors and other healthcare professionals for obesity-related issues. In addition to doctor's appointments, this includes visits to diet centers, fitness clubs, and weight loss programs.
The Insurance Authorization Process
The lengthy authorization process will begin when your bariatric surgeon sends your primary care physician a letter asking him or her to verify the "medical necessity" of your surgery for obesity. Your doctor can establish this by proving that any of the following apply to you:
  • You are morbidly obese with a BMI (body mass index) of 40 or higher
  • You have suffered from morbid obesity for at least the past five years
  • You have attempted, under your physician's care, other methods of weight loss for at least two years
  • You have co-morbidities – such as hypertension, diabetes, sleep apnea, degenerative arthritis, and heart disease – that constitute medical necessity for obesity surgery
  • You do not have major psychiatric or emotional problems
Any of the following that apply to you should also be mentioned :
  • You have significant liver, kidney, or gastrointestinal disease
  • You have a history of alcohol or substance abuse
  • A thyroid test has been ordered and results will be sent to your surgeon
The Appeals Process
Even if your pre-authorization for obesity surgery coverage is denied by your insurance company, there is still a chance that you can receive full or partial coverage for the cost of your bariatric surgery through the appeals process. During the appeals process, you may contest each reason your insurance company has given for denying coverage. It is critical that you submit your appeal quickly in order to have the best chances for a successful outcome. In some instances it may be helpful to employ the services of an insurance advocate or lawyer to help you effectively navigate the appeals process. Your insurance company may limit the number of times that you can appeal for weight loss surgery coverage, so make sure that you understand the guidelines set in your "certificate of coverage."

Financing Can Help Cover Weight Loss Surgery Costs
If you have gone through the approval, authorization, and appeals process and are still unable to get insurance to cover the cost of bariatric surgery, you still have options. Many financial lenders offer financing to help make payment for weight loss surgery easier on patients. Financing is also an option for those with benefits that only cover part of the cost of their gastric bypass or LAP-BAND® surgery. Many surgeons understand that weight loss surgery is a high cost procedure that yields beneficial life-changing results, so they are often willing to assist patients by providing information on available financing programs and payment plans.

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