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If you have started your research into bariatric surgery insurance coverage, you may have found it has one of the longest preapprovals of any surgery. While there is a clear and wide-ranging medical benefit to treating obesity surgically, insurance companies have not made access to weight loss surgery as easy as it should be. The result is an often-convoluted process that can take months.
There are, however, ways we can maximize our time during the preoperative process and take steps to ensure the preapproval comes as quickly as possible.
First, we encourage you to contact our office and your insurance company to verify your benefits. This involves a discussion with a benefits manager who will let you know what insurance will cover and how much, if anything, you will be responsible for.
This call is also a great time to discuss what documentation the insurance company needs for the preapproval process. Unfortunately, it’s not as easy as submitting a few sheets of paper. Instead, insurance companies want to know the procedure is performed out of medical necessity and not cosmetic reasons. They will require documentation from your primary care physician, your bariatric surgeon, and possibly other medical professionals. They may need a history of failed weight loss attempts and proof of long-time obesity.
The insurance company will also require preoperative testing, which is vital to ensuring a safe and effective procedure. You may need cardiac clearance, pulmonary clearance, a sleep study, and more depending on your circumstance. The tests ordered will be based on your medical history.
A medical weight loss program may also be required. This can last anywhere between three and six months and serves to prove to the insurance company structured weight loss programs without surgery continue to be ineffective.
Staying on top of these requirements throughout the pre-op process makes the process significantly quicker. In fact, the longest delays our patients have are in compiling the documentation and undergoing testing.
Further, ensuring all your documentation is accurate and conforms to the insurance company’s needs can save weeks or even months if the preapproval is denied due to a clerical error or oversight.
What Are My Other Options?
Of course, not all patients will use their insurance company to pay for their operation. As such, there are options for those without insurance or those who do not wish to use their insurance in case their deductible and copayment is high. Patients can look into financing options through third-party financing, credit cards, friends and family, or personal loans. There’s also the option of paying the out-of-pocket rate for the procedure known as cash or self-pay. Typically, these self-pay rates are significantly lower than what would be billed to insurance and may even be lower than the out-of-pocket expense through insurance.
While it’s easy to get discouraged with all the paperwork and preop testing you need, it’s also worth remembering this is a life-changing process, and it is not easy. Pushing through the preop process is an exercise dedicated to your renewed health. Of course, we are always here to help in any way we can, so please don’t hesitate to contact us to understand more about the insurance approval process.
