Using Insurance For Bariatric Surgery

When considering bariatric surgery, one of the first questions most of our patients have is whether their insurance will cover the procedure. We have written a guide below to help you with the insurance process. If you have any additional questions, please don’t hesitate to call or contact us today.

First and foremost, contact your health insurance company and ask “Do you cover bariatric surgery?” Then, find out if they cover the specific procedure that you are interested in having done — eg. Lap Band, Gastric Bypass or Gastric Sleeve. This will give you an idea of bariatric surgery insurance coverage potential.

It is always a good idea to keep a record of who you spoke to and specify dates and times. If you have questions and/or concerns, contact the bariatric coordinator that you met with at your consultation visit. They will be your surgical liaison throughout your preoperative journey.

The information below is to be used by you and your primary physician to maximize your likelihood of a speedy and uncontested insurance approval for your bariatric surgery. Copy this and bring it to your primary physician at your next appointment — the sooner the better!

Important Information from Your Primary Physician

Important information is now required for bariatric surgery pre-approval from 95% of commercial insurance companies. This includes documentation of 6 consecutive months of a physician-supervised weight loss program. Without this information, the approval process is impossible and will almost certainly be delayed up to one year! In addition, if the following information is not available, denials or delays always follow.

In order to best comply and help us with the pre-approval for your bariatric surgery insurance coverage, begin the following steps ASAP:

  • Go to your primary physician’s office and get weighed and make sure that they document your weight in your chart.
  • Have your physician recommend an exercise and/or diet regimen and document this recommendation in your chart.
  • Go back to your physician’s office at least every four weeks and weigh-in. Have them document your weight. Make sure this is recorded in your chart.
  • At these evaluations, also have your physician note your progress and make recommendations as to how to proceed with improving your progress. Documentation is critical! A full note must be written noting your progress and the recommendations given.
  • If the diet and/or exercise regimen is not effectively helping you lose weight, go see your physician again and have him/her recommend an alternative program.
  • Continue the weigh-ins. Have copies of this record available when you come in to see our physicians.

If your primary care physician has questions or concerns about this plan, please have him/her contact us directly. If this information is in hand at your consult with us— the approval process, if you qualify for surgery— is usually quite easy. We will make every effort to expedite the process for you at this point.

How this is often done:

Note: Specific diets mentioned are for the purpose of illustration only. They are not meant to be a guide for, or suggestion of treatment options.

For example, it would be great to have your physician recommend Jenny Craig for 6 months. Have him/her record the recommendations and your agreement to try them. Documentation at every encounter is critical and will need to be available to present to your insurer. The more details the better.

Make sure that there are visits during the interval of your diet regimen and weights recorded — monthly at least.

Using a diet regimen is not a recipe for failure, although we must note the following. You may lose some weight, but it has been proven that for the morbidly obese individual, the “success” of traditional weight loss regimens is less than 5%. ALL of you have experienced this first hand already.

We hope that this memo will prevent the delays in the pre-approval of the bariatric surgery insurance process and the denials we have unfortunately seen in the recent past. If you have questions, please contact us. We appreciate your help.