Gastric Bypass Insurance Coverage
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.
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.
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.