Now that you have explored the option of bariatric surgery and believe it is right for you, you will need to examine how to pay for the surgery of your choice. In many cases, your medical insurance policy may be able to cover some or most of the cost of the procedure and can therefore be rather affordable. The staff here at Dr. Follwell’s practice can work with you to help determine if you qualify for insurance covered procedures and if so, what you can expect to pay out of pocket. Even so, it is very important that you check with your insurance carrier to determine exactly what is and isn’t covered by your policy as this can vary between states and carriers. Of course, weight loss surgery can also be paid for by cash with no insurance company involvement.

In order to ensure the highest degree of compliance with insurance policy standards keep ongoing documentation of the following AND any other documentation your insurance policy may require:

• A detailed list of previous weight loss attempts (for up to 5 years) including medically supervised diets, weight loss programs, and gym memberships. Insurance carriers will expect to see a track record of trying to lose weight.
• Co-morbid conditions including diabetes, high cholesterol and high blood pressure.
• Current medications
• Doctor visits for obesity-related issues
• How morbid obesity affects the quality of your life
• Upon examination, we will provide you with a letter stating the "medical necessity" of the surgery if applicable, but you will also want to get a similar letter from your primary care physician. This lets the insurance company know that your condiditon is either life threateneing or will be at some point in the near future.

Every health insurance policy is different and it is important to understand your Certificate of Coverage. Read your insurance policy in detail, including what it covers and what it excludes. If your insurance carrier denies bariatric surgery coverage, you may be able to appeal the denial.

Appealing a Denial

If the insurance company turns down your request for bariatric surgery, you may be able to appeal the decision. Many people do not take advantage of the appeals process or know of the laws that govern insurance companies in their state. It is critical that you work with us to determine the correct approach to appealing a denial. We are here to assist you and to help you adhere to your policy’s requirements.

With a suitable insurance policy, the medical necessity for bariatric surgery, proper documentation and a proven track record of having tried to lose weight, patients who qualify for bariatric surgery in most cases will have a smooth and uneventful insurance review and approval.