Are you looking for Weight Loss Surgery Insurance Secrets? If you are considering having surgery to help you lose weight, you may have a tough time convincing your insurance company to pay for it. When it comes to you and your insurance company, the cost of not undergoing surgery is sometimes significantly more than the cost of actually having the procedure done. Anyone who is thinking about having bariatric surgery but is unsure how to pay for it has arrived at the right place. With the help of these six suggestions for the process that are favorable toward insurance coverage, it is possible to reclaim control of both your health and your happiness after having weight reduction surgery.
Secret 1: To obtain coverage, you should consult with your bariatric surgeon.
Insurance policies that cover weight reduction surgery may or may not extend their coverage to include bariatric surgery. Before you can even be considered for coverage, you must first overcome a significant number of obstacles. In order to be eligible for consideration by the majority of insurance carriers for bariatric surgery, you are required to fulfill the following requirements:
- Comorbidities associated with obesity in patients with a body mass index (BMI) of 35 or higher
- Obesity is not accompanied by any other kind of medical issue (you can calculate your BMI here).
- paperwork attesting to the fact that you took part in a weight-loss program supervised by a medical practitioner or another qualified healthcare expert.
- an explanation as to the reasons a patient ought to be treated
- The recommendation of your bariatric surgeon for surgical weight loss, together with the approval of at least one other practitioner in the field of medicine.
- Permission from a doctor to conduct surgery
- Before surgery may proceed, a clearance from a psychiatrist or other mental health professional is necessary.
- an evaluation by a dietitian who is licensed to practice
The vast majority of bariatric surgeons and their staff will help you file your insurance claim at no additional cost if you ask for their assistance. Bariatric surgeons provide this service because they are aware that a person’s financial situation can be a significant barrier to undergoing weight loss surgery and obtaining the degree of health that they envision for themselves.
Also Read: Is Sodium Bad for Weight Loss
As can be seen, there are a number of steps involved in the process of acquiring insurance. As a direct result of this, you need to get in touch with your surgeon as quickly as possible in order to begin the process of obtaining insurance coverage for your weight reduction treatment.
Secret 2: Your health insurance provider’s network ought to now include a surgeon who was previously ineligible for participation in that network.
The majority of insurance companies cover patients through a pre-existing network of medical professionals. In the event that they are not already part of your network, you have the option of adding your bariatric surgeon to it. You should start the enrollment process with your doctor as soon as it is practically possible in order to enhance the likelihood that your health insurance provider will cover the cost of your weight reduction surgery.
It’s possible that the procedure will be different if you have Medicaid or Medicare. Medicare will pay for a portion of the expenses connected with weight reduction surgery, including gastric bypass and lap band procedures.
Secret 3: In the event that your insurance provider does not pay for bariatric surgery, you might be able to negotiate a reduced rate for the pre-surgical treatments you need to undergo.
If you are having trouble finding health insurance that will fund weight reduction surgery, one option to take into consideration is having at least some (or all) of the pre-surgical testing and consultations paid for by the insurance company. In order to determine whether or not a potential patient is qualified for bariatric surgery, they will first need to go through a series of medical examinations and tests to see whether or not they meet the prerequisite conditions. The following are some instances of these tests:
- Evaluations of a person’s blood and cardiovascular and respiratory systems
- The scientific study of slumber (to test for sleep apnea, etc.)
- A mental health examination, in addition to counseling on diet and exercise, will be provided under the
- Supervision of a medical professional.
It is possible that pre-surgical testing, which is also known as pre-bariatric surgery treatment, will not be covered if you do not have insurance coverage for weight reduction surgery. As a result of the fact that many of these operations are not tied in any way to surgical weight loss, it is feasible to explain them as being medically required. Because bariatric surgery is not covered by your insurance, it is important that you communicate this information to your doctors.
Secret 4: Your health insurance provider could pay for weight loss surgery if the law in your state requires them to do so.
The Patient Protection and Affordable Care Act mandates that a number of states must offer insurance coverage for bariatric surgery, which is used to aid with weight loss. If your state does not mandate that residents have bariatric surgery insurance, then it will be more difficult for you to find coverage for the procedure.
Also Read: Does Medicaid Cover Weight Loss Surgery
In 2019, the National Conference of State Legislatures stated that diagnosis and treatment of obesity were accessible in 33 states. (NCSL). In addition, a number of other legal systems consider obesity as a condition in its own right. As a direct result of this legislative action, insurance companies in 23 different states are now required to cover weight loss surgery. In addition, there are sixteen states that make it mandatory for insurance companies to pay for nutritional advice and medical treatment. Visit the website of the NCSL to get a detailed overview of the bariatric surgery insurance rules that are in effect in each state.
Secret 5: There is a possibility that your employer’s group surgery insurance plan can extend coverage to surgical weight loss procedures.
Work with your company’s human resources department to see if you can have your insurance coverage expanded to include weight loss surgery if you are employed by a large company that offers health insurance to its employees. Businesses that have at least 51 full-time employees have more clout when it comes to putting these reforms into action.
To get started, speak with a representative from human resources. Explain to them the situation you find yourself in. Include information on the myriad of ways that having weight loss surgery might benefit their company’s bottom line. If you refrain from discussing your personal experiences and feelings throughout your presentation, there is a better chance that the individuals responsible for making decisions in the human resources department will listen to your argument. As a result, you have an obligation to provide information on how workers’ health and wellbeing may be improved by weight loss surgery, how it can reduce overall insurance costs, and how it can improve employee performance.
Secret 6: By being creative and thinking outside the box, you may cut down on the money you have to pay out of pocket.
There are ways to reduce the amount of money you have to spend for weight loss surgery, even if you just have partial or no insurance coverage for the procedure. The following are some options that you might think about going with instead:
Some healthcare providers provide a discount or payment plan to individuals who are unable to obtain insurance coverage for weight loss surgery. This is an option for people who fall into this category. Simply asking your doctor whether they provide this service is the best way to find out if they do.
Your surgeon may be willing to reduce the cost of your surgery if you are able to make complete payment in advance. Repeat your inquiry with your primary care physician to determine whether or not the clinic provides this particular service.
If you want to reduce the cost of your bariatric surgery, you should investigate whether or not it is possible to have the surgery performed in the hospital. Certain surgeons have the credentials necessary to do procedures at a variety of hospitals and clinics. Find out which hospital your surgeon is affiliated with that offers the most reasonable prices for bariatric surgery if he or she is affiliated with more than one hospital.
Medical cost deductions are available from the Internal Revenue Service (IRS) if the total amount spent on medical care is greater than 10 percent of the taxpayer’s adjusted gross income. This implies that you are eligible to receive a tax deduction for the costs of your medical care.
The Essentials of Obtaining Weight Loss Surgery Insurance
Having surgery performed to aid in weight loss is unquestionably going to set you back a lot of money. Depending on the scale of the undertaking, the price might range anywhere from 14,000 to 33,000 dollars. The cost is also contingent upon the kind of surgical surgery that is carried out. Lap band surgery and gastric sleeve surgery are often less expensive options for weight loss surgery than gastric bypass and duodenal switch procedures.
Even if surgery is pricey, the total expense of your medical treatment would be far higher if you didn’t make an effort to reduce your weight first. In terms of your health, the costs and inconveniences associated with obesity-related ailments can add up quickly. To provide just one illustration, it is not at all unusual for obese people to:
- Cardiovascular disease
- Kidney disease
- Sleep apnea
People who make no effort to reduce their weight may find themselves with exorbitant medical bills for things like hospital stays, prescription drugs, lab tests, and doctor’s visits. You shouldn’t let the fact that you don’t have health insurance derail your attempts to get healthier and lose weight. Have a conversation with your bariatric surgeon about how to get started on your road to a healthier weight.