Will My Insurance Pay for Surgery?
For so many, weight loss surgery is like being handed keys to a new life! The years of struggle, shame and futility are finally a thing of the past. It’s a beautiful thing! But navigating the process of actually getting bariatric surgery can be a struggle all its own.
It Depends on Your Policy
The influence of insurance in healthcare is undeniable and more prominent than ever. If you’re like most, your health insurance is dictated by your employer. In these cases, plans are selected based on coverage and affordability – which can vary widely based on the size of the employer. In the end, you’re at the mercy of whatever coverage your policy dictates. For those suffering from obesity and hoping to have weight loss surgery, insurance can be the ultimate YES or NO.
You’ll Need to Meet Requirements
So what exactly is the process? Well, we’re certainly glad you asked! Every policy is different, but the initial qualification that ALL insurances require is a BMI (Body Mass Index) of at least 40 (or 35 with a comorbidity like diabetes or high blood pressure.) If you don’t meet that threshold, weight loss medications or dietary guidance can still be an option, but you won’t be approved for surgery. Beyond BMI, insurance will likely have additional requirements (Step 3 in the chart below)…
How Long Will it Take?
This is probably the most common question we get from surgery candidates. The answer: it depends. If your insurance requires multiple diet visits,for example, it could potentially take six or more months to complete. The best advice we can offer is to make sure YOU know exactly what your policy requires so you can plan accordingly. This will also help you figure out the best timing as it relates to things like deductibles and out-of-pocket maximums. The average time from an initial consultation to surgery day for most patients is 90 – 120 days.
I Don’t Have Bariatric Benefits, What Can I Do?
Although coverage for bariatric surgery is very common nowadays, not every policy provides benefits. So what if you’ve tried everything and surgery is your last hope, but your insurance won’t pay? You still have options. Remember, it took you a long time to gain the weight and you’ve probably been trying for most of your life to lose it. Be patient and stay focused on getting to surgery. And consider these:
- Before it’s time to choose your benefits for the year, make a call to HR and ask specifically about weight loss surgery. Often, the PPO plan offered includes weight loss surgery coverage while the HMO plan does not. And if none of the insurance plans offer weight loss surgery, ask why. There is great evidence available that shows the health benefits of weight loss surgery. Not only will having the surgery change your life, it will make you a more productive worker!
- Consider a medical loan. Many bariatric programs work with companies that offer loans for patients who want to undergo bariatric surgery but do not have insurance coverage. Your car probably cost more than bariatric surgery. Which one will make you healthier and feel better? And many practices offer cash-pay surgery packages that are more affordable – so ask them.
- Consider a job with amazing benefits. Yes, in some cases it may make sense to look for a new job just for the benefits.
We’re On Your Side
If after consulting with the doctor, you decide that surgery is your best option, our team at Weight Loss Specialists of North Texas will work hard to move you through the approval process as quickly as we can. Once all requirements have been met and final submission has been made to insurance, it takes about 15 business days for approval. From there, we schedule your pre-operative appointment, get you scheduled for surgery and you’re on your way to a NEW you! If you’ve been considering weight loss surgery or perhaps you have a friend or family member who has, get started today: https://weightlosssurgeon.com/contact/. At Weight Loss Specialists of North Texas, we’re committed to treating you with no blame, no shame, compassionate care that gets results.
