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Some insurance plans cover weight loss surgery and some dont. To find out if your plan will cover the surgery, you should call the benefits coordinator in the human resources office at your work or call the customer service line on your insurance card. When talking with your insurance plan, you should take detailed notes including the name, position, and phone number of the person who is giving you information. Ask the question "If my doctor feels that laparoscopic gastric bypass for morbid obesity is medically necessary for me according to the guidelines of the National Institutes for Health, will surgery be a covered benefit?". If the answer is yes, ask what the plan requires prior to approving surgery.
Our office will send a letter, called the letter of medical necessity, to your insurance company requesting coverage for surgery. Most insurance plans require that your medical records accompany the letter of medical necessity, so it is important that you or your referring doctor get copies of these records to our office as soon as possible. Some plans cover weight loss surgery when patients meet the NIH criteria, while others have more limited restrictions on coverage. Some plans require a program of medically supervised weight loss for up to six months immediately preceding surgery. If your insurance plan does cover laparoscopic gastric bypass, it may take as little as two weeks or as long as several months from the date we send the letter of medical necessity to get approval for your surgery.
If your plan denies coverage for weight loss surgery, you can appeal this decision on your own or we can refer you to a company that will pursue your appeal. You may wish to try to switch insurance plans to one which pays for medically indicated weight loss surgery. Some patients may even need to switch jobs to be eligible for a plan with benefits which include weight loss surgery. Unfortunately, some patients end up paying for weight loss surgery from their own funds.
What if my insurance company won't pay for the surgery?
Some patients end up paying for weight loss surgery from their own funds. For these patients, we can refer you to companies which offer financing for medical procedures. It is important to obtain not only the expected cost of surgery, but also an estimate for charges for any potential complications. These will likely not be covered by your insurance plan. Although most of our patients do not have complications, when they occur they can lead to a hospital bill of several hundred dollars for an extra day in the hospital, or they can amount to tens of thousands of dollars for a prolonged stay in the intensive care unit. For patients paying for weight loss surgery from their own funds, our surgery fees include the surgeon, the first assistant and all hospital and out patient post-operative care for 90 days after surgery. These fees are collected at our office no later than 5 business days prior to the scheduled day of surgery in the form of a cashiers check.
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