How to get Insurance Approval for Bariatric Surgery

Weight-loss surgery helps people who have tried everything to lose weight such as exercise and diet-control. It is very effective in reducing significant amount of weight in obese and severely obese people. Commonly known as bariatric surgery, it is proved to have long-term health benefits. 
Banana Weight Loss Photo - - source obesity is one of the leading causes of preventable deaths in US, according to the Centre for Disease Control and Prevention. Severe obesity, also known as morbid obesity, starts at a body mass index of 40. In US alone, this disease leads to medical conditions which cost United States about $100 billion per year.
It has been proven through various studies that severely obese people are at higher risk of having cardiovascular problems, hypertension, type 2 diabetes, high cholesterol, infertility, gall-bladder problems, cancer and depression. Bariatric surgery comes as a lifesaver treatment for such people who have had successive failures with conventional obesity treatments and strategies like medication and exercise. In this treatment, making changes in the digestive mechanism of body restricts the amount of food-intake. 
About 40 years ago, this surgery was conceptualized in surgeries for cancer and severe ulcers, which involved removal of a large portion of small intestine or stomach. Weight-loss through bariatric surgery is achieved mainly by restricting the capacity of stomach to hold food. The two main techniques used by surgeons to produce weight-loss are:
  • Restrictive surgery also known as gastric sleeve surgery: In this procedure, one section of stomach is removed in order to shrink its size. This limits the amount of food in stomach and makes one feel full. 
  • Malabsorptive surgery: Most of the digestion and absorption in body takes place through small intestine. Surgery of this section of digestive system, limits the amount of food that is entirely digested or absorbed, resulting in malabsorption. Today, doctors perform this surgery along with restrictive surgery. 

Getting approved by insurance companies for bariatric surgery: 

Several insurance companies now consider that obesity is a major life-threatening disease like high blood pressure, type-2 diabetes, cardiovascular disease, and high cholesterol. According to the American Society for Metabolic and Bariatric Surgery, there are many evidences to prove that bariatric surgery can help cut down more than thirty weight-related health problems.
Looking into the cost of the surgery, the majority of patients want to get approved for insurance to cover their weight-loss surgery. They have several assumptions about the policies and procedures related to getting approval from insurance companies. If you have health insurance and you want to undergo weight-loss surgery, it is important to read the policies and discuss with your insurer and surgeon to ensure that you get approval for your weight-loss surgery. 
Most of the insurance companies ask for documents to prove that your surgery is essential. Discuss with your surgeon to check your medical history and provide all the documents for your obesity-related health issues. In addition to this, some of the insurers require complete psychological evaluation of the patient to rule out unhealthy lifestyle and some psychological health problems. When all the required evaluation is done, your doctor will provide a pre-authorization letter to the insurance company. The letter will have your complete medical history and other obesity related health problems. 
The following info is generally required in the pre-authorization letter:
  • Body weight, weight-history and BMI
  • Complete description of obesity-related health problems and treatment records
  • The description of problems your weight creates in your day to day life
  • Detailed info about the results of diet-efforts, medical and non-medical diet regimes undertaken
  • Detailed history of exercise regimes, including health club memberships. 
The insurance company will review your case and if there are symptoms of any other weight-related problems, it may request another diagnostic test such as cardiac or sleep apnea tests. While these procedures are in progress, you should keep a track of all the communication between your insurer and your doctor. Keep a copy of all the documents, letters sent and received. 
On the other hand, if you do not have a health insurance, you might have to pay the entire cost yourself. However, some clinics can help you in financing a loan which you can repay over the years.
Learn more within the Bariatric Surgery Resource Guide. To consult with doctor who performs Bariatric Surgery, look through profiles to find a specialist in your area.