Insurance and Weight Loss Surgery

January 2, 2007 · Filed Under Weight Loss Surgery 

Congratulations! You have decided to take the plunge and have weight loss surgery. However, there is one thing hanging over you, money. Luckily, many insurance companies feel that weight loss surgery is beneficial to both of you, and can make your surgery affordable.

Obtaining insurance approval may not happen overnight. You are probably not the only candidate vying for weight loss surgery, which can average around $25,000. Weight loss surgery has increased in popularity over 800 percent since 1994. Because of this increase in demand and the high price tag, your insurance company may not be so willing to pay. Insurance companies are in business to make money and there is no guarantee that you will stay with their company for life.More...

There is one main step to getting insurance approval so you can be on your way to a healthier lifestyle!

Most insurance companies will require a letter of medical necessity from your bariatric surgeon and your primary care physician. They need “proof” that the weight loss surgery is for necessity and not for beauty. The purpose of this letter will be to show that you are obese and that your obesity is a health challenge.

You can help your doctors write this letter by supplying information on your weight and diet history. Be sure to get a list from the insurance company on what they need to receive. The following is information your doctor should include in this letter to the insurance company.

Name, birthdate, weight and height. Your body mass index (BMI) will also be included, as well as any health related conditions that you have due to being obese.

Make a list of all the restrictions being obese has on your daily life and activities and include these.

The insurance companies will also want to know what your diet history is, including your successes and failures. Review all of the diets and weight loss programs (including medically supervised and diets you have tried on your own) and make a list of the diets, results and failures. If you know the reasons the diet failed, make note of that.

Also include all prior fitness programs you have been involved in, such as fitness clubs or classes. Include receipts as proof.

When your doctor is putting together the letter, make sure to have them include information from medical journals, studies and other medical research that will help show the insurance companies why they should grant you approval.

Find out if your insurance company will need a nutritional consult and/or psychological evaluation. Your surgeon can help you set up these appointments.

Also be aware that some companies may require you to participate in a physician-supervised diet and will ask for at least six months of detailed documentation (including weigh-ins and dietary supervision) on the results of this diet.

It is a good idea to ask all the doctors who have treated you in the past for letters of recommendation. Have them send the letters to you instead of the insurance company so you can make copies and send the ones that support your cause.

This letter of medical necessity needs to prove that other alternatives have been tried and were not successful and that weight loss surgery is your only option to a healthy future.

Pull your records and include other medical problems you have that are obese related. These include high blood pressure, diabetes, cardiovascular disease, arthritis and other weight related health issues.

Chances are your doctor and weight loss surgeon have been through the process of getting insurance approval before. Ask them who you can talk to in their office that can help you through the steps to obtaining your insurance approval for weight loss surgery.

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