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Bariatric Surgery Insurance
INSURANCE
COVERAGE FOR GASTRIC BYPASS, SLEEVE AND BANDING
As the number of Americans diagnosed as severely or
morbidly obese continues to grow, so does the need for
gastric bypass surgery. Insurance companies are aware of
this medical necessity, and many have added coverage for
gastric bypass surgery into their policies in cases where
the surgery is found to be medically necessary.
Prior to considering any sort of weight loss surgery , you
should make sure that you fall within the guidelines as
outlined by The National Institute of Health (NIH). Obesity,
in general, is determined by one's Body Mass Index. This is
calculated by dividing your weight in kilograms by your
height in meters squared.
Qualifying for Insurance Coverage
To qualify as an ideal candidate for gastric bypass surgery
under NIH guidelines, a patient's BMI must be 40 or higher.
(A BMI of 40 is roughly 100 pounds overweight for men and 80
pounds overweight for women.) A patient with a BMI between
35 and 39.9, who has been diagnosed with a serious
obesity-related health issue (e.g., severe sleep apnea,
heart disease, or Type 2 diabetes), may be eligible for the
surgery, as well. The NIH also emphasizes that understanding
every detail of the operation and the changes within your
own lifestyle that you will need to make is of extreme
importance.
Before deciding to move forward with gastric bypass surgery,
you should investigate the terms of your insurance coverage
in depth. Some insurance companies have made exclusions for
employers, meaning that your employer may have the option of
not covering the procedure even if it has been determined a
medical necessity.
Gathering Evidence
Your insurance company may require a physician's
documentation proving your history of severe or morbid
obesity. Your primary care physician can provide copies of
your office visit records that demonstrate ongoing weight
issues. (Your insurance company will only want to see
specific visit records a letter from your physician
describing your ongoing obesity is not acceptable.) Also, be
sure to include documentation from both present and past
physicians who have treated you.
Your insurance company may also require you to submit all
records of medications your physician has prescribed to you
for the purpose of weight loss. Additionally, records from
any diet programs you have participated in may be useful. If
you are seeing a licensed psychologist or psychiatrist, or
if you are currently taking any prescribed medications for
mental health, you may be required to undergo a psychiatric
evaluation to qualify for insurance coverage for your
gastric bypass surgery.
In addition, depending upon the type of insurance you carry,
you may be required to have a referral or stay within a
network of providers. Ask your insurance company for any
information or guidelines on coverage of obesity surgery.
Your request for coverage may be denied if you fail to
provide the necessary documentation, so you should research
exactly what you need when beginning the process.
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