Bariatric Surgery Insurance and Financing
Depending on the type of bariatric procedure you get, you must consider the cost of your surgery. There are many hospitals and finance companies willing to help pay for your treatment. In recent years, insurance companies have begun to pay for much of the cost of bariatric surgeries. They realize that the surgery will cost them less in the long run because of the sharp increase of health care costs due to obesity. Health care costs overweight- and obesity-related diseases and disorders is now equivalent to the cost of smoking-related illnesses, totaling nearly 100 billion dollars a year.
Your bariatric surgeon will most likely prove the medical necessity of your bariatric surgery if you meet the National Institutes of Health requirements of co-morbidities. Meeting the medical necessity test is required for your insurance carrier to cover the costs of surgery.
Securing insurance coverage for bariatric surgery
Securing insurance for bariatric surgery can be a long and complicated process. Criteria for insurance coverage for bariatric surgery varies based on your state, insurance policy, and carrier. Many bariatric surgeons offer payment plans to help you manage the cost of your bariatric surgery, but the cost is dependant on several factors: who is performing the procedure, where the surgery will take place, and what type of insurance, if any, you have. Many public and private insurance companies pay up to 80% of bariatric surgery costs, but coverage varies among insurance carriers. The following points detail the typical steps a patient must complete to receive coverage for bariatric surgery:
- Become familiar with your insurance policy or certificate of coverage
- Obtain a bariatric surgery referral from your primary care physician
- Keep records of all your weight-related medical appointments
- Obtain documentation from your bariatric surgeon detailing the medical necessity for your bariatric surgery
Requirements for bariatric surgery insurance coverage
Most major insurance companies require some combination of the following items for bariatric surgery coverage:
- Several years of a patient&39;s medical history
- Diet and exercise records ranging from three months to a year
- Recorded histories of obesity ranging from two to several years, accompanied by weight loss attempt documentation
- Psychological evaluations and clearance
- Compliance letter from the patient
- Lab work and tests for cardiac, pulmonary, sleep apnea, other co-morbidities
- Monitored physician diet plans, physicals, and so forth
Bariatric procedures not covered by insurance
Most insurance companies will not cover or will minimally cover the following bariatric surgeries or related procedures, though coverage varies between companies.
- Gastric sleeve and duodenal switch, which are considered experimental procedures
- After care that is billed separately such as dietician, psychologist, exercise programs, and nutritional supplements, like vitamin B12 injections
- Procedures that are not deemed medically necessary
As the patient, you are responsible for payment of any procedures your insurance does not cover.
Medicare and Medicaid coverage of bariatric surgery
Medicare and Medicaid are also increasing their coverage of bariatric procedures, depending on the medical condition of the patient. Medicare currently pays for the following types of bariatric surgery:
- Gastric bypass
- Laparoscopic Roux-en-Y gastric bypass
- Laparoscopic adjustable gastric banding
- Open and laparoscopic biliopancreatic diversion with duodenal switch
Medicaid coverage for bariatric surgery varies on a state-by-state basis.
Appealing to your insurance company
Your insurance company may deny coverage for bariatric surgery after your pre-authorization request. If the initial attempt to authorize coverage is denied, you can appeal the decision immediately. You still have a chance at receiving full or partial coverage for the cost of your surgery through the appeals process.
During the appeals process, you can challenge each reason your insurance company has denied coverage. It is important to submit your appeal quickly. In some instances you may need to consult an insurance advocate or attorney to help you effectively navigate the appeals process. Your insurance company might have a limit to the number of times that you can appeal for bariatric surgery coverage. You must read the guidelines set forth in your insurance policy or certificate of coverage.
Financing bariatric surgery
Financing helps patients afford the medical treatment they need to lose weight and improve their health. If you don't have health insurance, your health insurance doesn't cover all the costs of surgery, or you don't have Medicare coverage, and you don't have the money to pay for surgery, co-pay, or deductible, you can opt for financing. With bariatric surgery financing, you can break down your surgery cost into manageable monthly payments.
Methods of paying for your surgery outside of insurance include the following:
- Finance through the surgeon, your bank, or a bariatric financing plan
- Borrow from a 401(k), mutual fund, home equity, or savings plan
- Pay with a credit card or cards
As a patient and consumer, you can search for different types of medical finance companies and compare terms, interest rates, and credit limits in order to find the best loan for your situation. You can also check your local bank or credit union for medical loans or personal loans. The loan process typically begins by submitting a loan application, which can often be done online through the lender's website. The lender will review your credit history, current income, current assets and liabilities, and credit amount requested in order to determine loan eligibility, rates, and approval.
Most bariatric surgeons have working relationships with health care financing companies and can help you with various financing options. Consult with your bariatric surgeon for more information on financing and payment plans. If financing is offered through your surgeon's practice they will usually offer fixed interest rates, flexible payment options, and low monthly payments.
Established patient financing programs in which many bariatric surgeons participate are available for the LAP-BAND® and REALIZE™ Band procedures. Consult with your bariatric doctor to find out if his or her practice offers these bariatric financing programs.
Find out more about bariatric surgery
For more information on bariatric surgery, browse the menu options above. To find a bariatric surgeon near you, use our bariatric surgeon locator.
Review the average costs of bariatric surgery.