Does Your Insurance Cover Bariatric Surgery?

Does Your Insurance Cover Bariatric Surgery?Many health insurance plans cover bariatric surgery, but every insurance plan is different. It’s important to review your benefits brochure carefully. You can also speak directly with an insurance agent, who can tell you:

  • Whether bariatric surgery is covered
  • Which types of bariatric surgery are covered
  • Your co-pays and deductibles
  • Which surgeons are within your network

Here are some points you should know about insurance coverage for surgery:

  • Pre-approvals. To make sure the procedure is covered under your policy, pre-approvals are usually required by your surgeon. Typically, your surgeon's office will submit the required information, or you can do it yourself. In either case, it doesn't hurt to contact your insurance carrier directly to follow up.
  • Certificate of coverage. Your insurance company is required by law to give you a “certificate of coverage”. If you don't have one, consult your employer's human resources or benefits administrator or ask your insurance company directly. Be sure to take the time to read it and ask any questions you may have.
  • Medical records. In order to gain access to coverage, you may need to provide your medical records. Coordinate with your doctor's office and your insurance company regarding all communication and documentation related to your case.
  • Appealing a decision. You may have to try several times for approval. Make sure you have completed all the required steps and given your insurance company all proper documentation, and then write a letter of appeal to your insurance company explaining why you should be approved. Your doctor’s office may be able to assist you, but it's important to act quickly.
  • Talk about next steps. If your insurance policy offers coverage for weight loss surgery, but denied you because you didn’t meet their requirements, don’t lose hope. Your surgeon is your best ally. Talk to your surgical team to determine your next steps.