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Have you been considering getting gastric bypass surgery?
If so, you’re not the only one. There’s no secret that Americans are getting heavier. According to a government study released in late 2018, the average weight for men jumped from 190 pounds in 2002 to 197.9 pounds in 2016. For women, the numbers went from 163.8 pounds in 2000 to 170.6 pounds in 2016. Meanwhile, average height stayed the same. In other words, Americans are getting wider, but not taller.
As a result, more overweight people are looking into inventive ways to slim down. Weight loss is a lengthy process which requires discipline and patience, as well as a serious amount of motivation and a strong support system. However, when diet and exercise only take you so far, it’s natural to be tempted to look into alternatives.
Weight loss surgery is at the top of the list as it can substantially increase the life expectancy of the patient by improving weight-related conditions like high blood pressure, sleep apnea, cholesterol abnormalities, arthritis, and more.
Already know all this? Then you’ve probably talked to a bariatric surgeon about the pros and cons, as well as what kind of gastric bypass requirements there are before, during, and after your procedure.
Before you proceed with the surgery, there’s one more thing you need to take care of: The cost.
Do you have insurance coverage for bariatric surgery? Are you 100% sure?
Before you schedule your surgery, it’s best to count the cost. Learn all you can about your insurance company and their coverage for this type of procedure.
Insurance Coverage for Bariatric Surgery: Do All Insurance Companies Cover the Weight Loss Surgery Cost?
Insurance companies typically won’t cover a medical procedure they deem “experimental.”
Fortunately, these days, many of the weight loss surgeries have been proven effective so that many insurance companies are willing to cover the cost.
Those who run these companies would rather pay for a procedure that can potentially prevent these conditions than have to pay for them down the road.
This is especially true since heart disease and diabetes can affect a person’s health for years, whereas with gastric surgery the insurance will only have to pay out one time.
As you can imagine, patients are excited by this because it means that they don’t have to pay for 100% of their surgery. The cost typically comes out to around $20,000-$30,000 depending on where you live and your doctor’s expertise.
Unfortunately, not all insurance companies cover weight loss surgery cost. Some have very stringent gastric bypass requirements that patients and/or doctors need to meet before the insurance considers payment. Others will pay for certain gastric surgeries, but not all of them.
If you have insurance coverage for bariatric surgery, most plans will cover anywhere from 50% to 100% of the total cost.
What about patients on MediCare?
MediCare is U.S. government funded insurance coverage for people over the age of 65 years. They will cover gastric surgery, but they have some conditions.
First, the person has to have a BMI of 35 or over, and they have to have at least one obesity-related condition, like diabetes.
Gastric Bypass Requirements: What You and Your Doctor Need to Do
In order to ensure that you really do have insurance coverage for bariatric surgery, there are some gastric bypass requirements that you’ll need to adhere to. Here’s how to make sure you meet those requirements.
Find Out What Kind of Gastric Bypass Requirements Your Insurance Has
In order for your insurance to cover the weight loss surgery cost, talk with them about their coverage guidelines.
For example, as was mentioned, MediCare requires that patients have a high BMI and at least one obesity-related illness.
Other private sector companies might require something similar.
Don’t simply look at your insurance handbook to find your answers. Call your insurance company and ask them if they cover the procedure you want to have.
It might be helpful to get the surgical and treatment codes from your surgeon’s office to get a specific answer about surgical coverage.
Make sure you get the name of the person you talked to and/or their employee number and keep it, as well as their answers to your questions, on file.
Ask Your Surgeon to Send a Preauthorization Form to Your Insurance Company
Just because an insurance rep said you have coverage for weight loss surgery doesn’t mean you have it. Mistakes are made all the time. Reps take phone call after phone call and can get confused.
And we don’t know all the ins and outs of surgical procedures, coding, and insurance coverage either. It’s easy for mistakes to happen.
One way to get a definitive quote from your insurance is to ask your doctor for a preauthorization form.
This form looks like an insurance claim form and nearly all of the information needed on a claim form is added to a preauthorization form.
The difference is that this form is sent prior to surgery to make sure that the insurance company is going to cover the procedure and at what percentage.
Get Your Insurance Coverage Straightened Out Before Committing to Surgery
There’s nothing worse than thinking your covered for a medical procedure only to find out you have to foot most, if not all, of the bill.
When this happens, it’s often due to misunderstandings of insurance coverage and policies.
Insurance companies have a lot of guidelines and regulations that patients and doctors need to meet before a procedure will be covered – if it’s covered at all.
Do your research. Talk to your insurance broker. Find out all you can about your coverage. Have your surgeon’s office send in a preauthorization form to get an exact estimate of coverage and gastric bypass requirements.
Taking these precautions will give you peace of mind, allowing you to focus on healing after your surgery instead of stressing out over unexpected medical bills.