. Losing weight takes work. But when you have too much weight to lose, and if exercise and diet are not enough, you can consider weight loss surgery, also called bariatric surgery.
You will probably have questions about how much it costs, which insurance covers and how to convince your insurance to cover the account. Here's what you should know.
Metacore Weight Loss - Financing Weight Loss Surgery
How much does it cost?
. Weight loss surgery is expensive. Typical costs can be performed from $ 20,000 to $ 25,000, according to the National Institute of Diabetes and Digestive and Renal Diseases.
The price of your weight loss surgery will depend on various factors:
- The type of surgery you are having. Weight loss surgery types include gastric bypass, adjustable gastric bands, vertical gastric bands (also called stomach stapling), glove gastrectomy and biliopancreatic deviation. Other options include intragastric balloons or even an electric implant device. Each one has a different fee.
- your surgeon rate. This varies according to where you live, the experience of your surgeon and the complexity of the procedure.
- The hospital you choose. costs vary and may include operating and hospital rooms, among other fees.
- Anesthetist fee
- Surgical assistant fee
- Device rates
- Consultant rates (if necessary)
- Follow-up procedures (for gastric band)
Will health insurance be paid?
If you have health insurance, read your policy carefully and work closely with your insurer and your doctor to see what is covered. Under affordable care Act, some states require health insurers that sell plans in the market or directly to individuals or small groups cover bariatric surgery; By 2016 almost half of states required coverage for these plans.
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Most insurance companies recognize that overweight and obese people are more likely to get serious health conditions such as type 2 diabetes, high blood pressure, heart disease, high cholesterol and sleep apnea.
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If you do not have health insurance, have insurance through a large employer (50 or more employees), or you live in a state that does not include bariatric surgery on your essential health benefits, you will probably have to pay all your own account. Some weight loss surgery centers can help you get a loan that you can afford for several years.
Most large insurance companies require:
- Proof that surgery or medical intervention is medically required. Your surgeon can help provide your medical history and documentation of your health problems related to weight.
- Participation in a medical supervised diet program. You may be required to successfully complete a 6-month weight loss program before approval to be granted. Medicare does not require this 6-month program, but you can be encouraged to participate in anyway. This type of diet program involves monthly visits to your doctor or bariatric surgeon office for 6 months. Insurance companies are not trying to figure out if you can lose weight through the diet. In fact, most insurance companies require that the patient's weight is stable during this period - no fluctuations on top and down - or you can be denied coverage. They want you to demonstrate over 6 months before surgery you can commit to lifestyle changes you need to do forever after weight loss surgery.
- a psychological evaluation . This is to ensure that you understand weight loss surgery and the impact it will have in your lifestyle. Psychological evaluation also checks for untreated compulsion or any other psychological issues.
- a nutritional evaluation. You will work one in one with a nutritionist to describe specific changes and dietary habits that need to be changed.
What happens next?
When you have completed these steps, the surgeon will send a pre-authorization request letter to your insurance company. The letter will delineate your medical history and health problems related to your weight and provide documentation that you have completed all requirements for approval.
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The insurance company will revise your case. If you have symptoms of weight-related conditions, the company can request specific diagnostic tests such as cardiac, pulmonary assessments or sleep apnea.
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During this period, keep precise notes of all communications between the insurance company and your surgeon. Keep copies of complete insurance forms, submitted letters and letters received.
What if your insurance company decreases coverage?
If your request is turned off, or if the insurance company agrees to pay only a small percentage of the cost, the door is not closed.
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You can write an appeal letter for the insurance company representative (as a claims supervisor) who signed the denial. Before appelling, make sure you fully understand your policy, and that does not specifically exclude weight loss surgery you want.
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In addition, make sure that the restrictions were not in effect when you started your contract with the health plan.
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Your letter of resource must include:
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- An explanation of why you feel that the procedure should be covered
- A complete explanation request from why coverage is being denied (or paid at a reduced level)
- An application for a copy of the specific declaration - withdrawal from the Booklet or Benefits - which explains why its cover is limited or denied
- A copy of the denial notification
- A copy of your doctor's pre-authorization request letter
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You may find it useful to send a copy of your letter to appeal to your state or corporate department insurance commissioner if you are covered by an HMO plan. You can explain that you are having problems and ask for help. Your bariatric surgeon can help you with your appeal.
Other ways to pay for weight loss surgery
If you do not have health insurance, or if your insurer will not cover weight loss surgery, talk to your doctor and your surgeon about financing plans. Check the interest rate and make sure that you are OK with all terms.
