Weight loss surgery can be expensive, and you will need to determine how you will pay for the surgical procedure. Most patients obtain insurance approval from their insurance carriers, and some patients choose to pay for the surgery themselves. We suggest you pursue coverage from your insurance carrier prior to paying for surgery yourself. Insurance companies are free to establish their own criteria for approval, but many follow the surgical criteria guidelines of the National Institutes of Health and The American Society for Bariatric Surgery.

Weight Loss Surgery Insurance Approval

Insurance approval is often a lengthy and complicated process. Our will assist you in obtaining insurance approval. However, they cannot act on your behalf since you are the policyholder. Therefore, you will need to work with our staff and remain active in the process.

Below are some steps you can take to ensure you have the best chance of obtaining coverage:

• Read your insurance booklet and/or speak to the insurance company prior to making any appointment for surgery. The insurance company is required by law to provide you with this information.
• Look at the section called "Exclusions."
• It must say "surgery," not just "weight loss," for it to be eliminated as an option.
• If you are required to obtain a referral prior to speaking with a specialist, contact your primary care physician and request a referral prior to attending your first appointment. It is always a good idea to consult with your primary care physician anyway, as his or her support is very helpful in the process.
• Locate your past medical records. Many companies require proof that you have tried other methods of weight loss prior to seeking surgery.
• If you keep good records, including receipts, bring those to your appointment. They can be used as verification of your attempts.
• A complete record of your health history must be sent to the insurance company, and your physician must also review that history to make the appropriate decision regarding your case. Therefore, be sure to complete all paperwork and answer all questions as completely as possible.
• A full description of all your health conditions, including records of treatment, medications taken and documentation of the effects these conditions have had on your everyday life is necessary
• A detailed description of the limitations your excess weight places on your daily activities, such as walking, tying shoes or maintaining personal hygiene is helpful.

The following is a list of insurance companies that we work with:

• Blue Cross Blue Shield
• United Health Care
• Sagamore
• Humana PPO

Insurance Denials

First requests are frequently denied, but don't be discouraged. You do have options. Insurance providers have an appeal process that allows you to address their denial. These suggestions may help:

• Appeal your denial immediately. There is usually a cut-off time after which they will not consider your appeal.
• Appeal in writing, and send it via registered letter.
• Make yourself a person rather than a faceless number in your letter.
• Clearly indicate how the obesity is hurting you.
• Include a budget summary to show how much money your obesity is likely to cost them in the next two years.

Some companies put limits on the number of appeals you may make, so be prepared if you go to appeal, and know the rules of your company's appeal process.