You have made the decision to have weight loss surgery. Maybe you have tried all the diets and they haven't worked. Possibly you are starting to have health problems due to your weight or want to avoid potential health problems. Getting insurance approval can be a long and frustrating process. Here are some helpful hints to make it easier:
- Call your insurance company and find out if they will pay for weight loss surgery and the follow-up care that goes along with the procedure. Ask for the criteria needed to qualify for surgery. Most companies will require documentation of weight loss attempts with diet and/or drugs. You might also need to have risk factors such as diabetes, sleep apnea, high blood pressure, and other health problems that are related to your obesity. Each insurance company has different criteria to qualify for weight loss surgery.
- Obtain all the documentation of health problems, treatment plans, tests, or studies and attempts at weight loss for the last five years. It will make things go a little faster if you have this documentation when you attend the information presentation at the surgeon's office. Our bariatric insurance specialist will inform you of any additional information needed for your file. Not obtaining this information requested could mean you will be denied for surgery or that the process of approval will be dragged out.
- We strongly encourage you to attend two support group meetings. This is an excellent way to talk with other people who have had surgery and listen to their experiences. Online support groups can also give you good information about the procedure that you are having. Obesityhelp.com, lapband.com, and wlslifestyles.com are good websites to check out.
- Be your own best advocate. If you haven't heard anything about approval, call the insurance company. It may seem like the insurance company isn't in a hurry to approve you for surgery. Remember that the contract is between you and your insurance company. Don't be intimidated to contact them.
- For patients who are having the lap banding surgery, you will first need to view the lap band emmi presentation on the computer. This is a computer presentation that guides you through the process of the surgery and aftercare for the lap band. For gastric bypass patients, there is a computer program that explains the bypass surgery and possible complications of the surgery. Contact the bariatric coordinator at 308-630-2249 to get further information on these presentations.
- Once you have been approved for surgery, you will need a psychological evaluation. This has to be done by a psychologist or psychiatrist. The bariatric coordinator can recommend someone in your area. The insurance specialist will advise you when you need to have this done.
The initial fees charged for the surgery include surgery and three months of follow-up care. Additional care beyond the three-month date is the responsibility of the patient, including appointments and band fills. Many insurance companies will cover this care in part, however, the remaining portion is the patient's responsibility.
There are also options if insurance doesn't cover weight loss surgery. We offer a self-pay arrangement, and the bariatric insurance specialist can help you with that process.
These hints should help you through the process of insurance approval and to the start of a healthier life.