Gastric Bypass Insurance Coverage

By Bart Icles

The top concern of people who desire to undergo “weight reduction” by means of a gastric bypass surgery is its cost. Even if one has a medical insurance policy, it doesn’t necessarily mean that they are covered in that area. Most insurance companies are willing to cover such procedures only when such a procedure is used for treating and correcting life-threatening diseases and conditions caused by excessive body weight or being morbidly obese, and which mostly likely will need the recommendations of a designated company physician. But in cases where patients are approved to undergo the procedure, the bulk of the payment may be placed upon with the patient themselves.

Health Insurance and Gastric Bypass Surgery

Gastric bypass surgery today costs from $20,000 to $25,000 at the most. Health insurance company’s views on such medical procedures greatly differ and vary, so if you ever you plan to undergo a gastric bypass surgery be sure to check and review you insurance policy carefully, or ask your insurance underwriter to determine your status on this. Most insurance plans exclude treatments for obesity, weight loss surgery and related treatments, so you will not get reimbursed for any charges you incurred before and after undergoing the surgical procedure.

Pre-Qualifying Process

If the patient’s insurance company has a contract with an HMO of which they are actively enrolled in, then they can get approval from the primary care physician and then be referred to a Bariatric specialist who will perform the weight reduction surgery. Once approved for the procedure, then the pre-qualifying process will be initiated.

If your request is approved, you still need to remember to include clauses for co-payment or co-insurance costs that will need to be paid out of your own funds. Again, check carefully if this is within the scope of your health insurance policy.

If you are denied by your insurance company, you can still appeal the decision with additional follow-ups with your doctors, supporting documents, or other important information asks by your insurer. The grace period to complete such requirements is from 30 to 60 days from the date of denial.

Medicare Coverage

With a Medicare coverage, the portion of the surgical costs and other related care may be covered – but only if you are obese and suffering its health related complications such as coronary heart disease, sleep apnea, hypertension, high blood pressure, type 2 diabetes, lower back and joint pain. Medicare does not cover gastric bypass surgery for overweight patients not suffering any health related problems, even if they are certified by a physician as being obese.

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