For morbidly obese individuals, weight loss surgery might be the only option to lose weight. You may ask your health insurance to pay for weight loss surgery. But your insurer may not approve your claim. The reason for this is that your situation is more complicated than you thought.
Why You Need Weight Loss Surgery?
We are getting heavier. In the US, the CDC reported that adult obesity doubled in the last 30 years. Many of these obese individuals are turning to bariatric surgery to resolve their issues but they must ask their health insurance to pay for weight loss surgery.
According to the American Society for Metabolic and Bariatric Surgery, the mortality rate for this operation after a month is around 0.13%. The rate is lower than other surgical operations, like gall bladder and hip replacement.
Its benefits outweigh the risks. It can increase life expectancy by up to 89%. After the operation, patients reported feeling better than if they did not undergo it.
Undergoing weight loss surgery may improve your blood pressure, asthma, breathing disorders, arthritis, sleep apnea, urinary stress incontinence, and other obesity-related problems.
Is It Right for You and Should You Insist Your Health Insurance to Pay for Weight Loss Surgery?
Sometimes, diets and exercise alone will not work to help you lose weight. If that happens, you may turn to weight loss surgery or bariatric surgery.
This type of operation involves operations on the stomach. Depending on your case, you may undergo a gastric bypass. It is open and laparoscopic surgery.
Restricting Ability to Eat Leading to Weight Loss
No matter what type of operation you will undergo, the goal is to restrict your ability to eat, resulting in weight loss.
After undergoing this procedure, you will have a smaller stomach that can hold a few ounces of food. If you eat too much, you will feel ill.
Furthermore, some bariatric surgeries involve digestion process alteration. Meaning it limits the absorption of calories and nutrients.
But not all obese individuals are good candidates. Doctors will only recommend it if you have a BMI of more than 40.
Even if you have over 35 BMI but you do not have obesity-related diseases, you may still not be a good candidate for this operation.
In that case, you will need to have an onset of medical conditions to be a good candidate so that you can insist on your health insurance to pay for weight loss surgery.
Not all people who wish to undergo this operation will get approved. If you still go for it and ask for your health insurance to pay for weight loss surgery, then your plan will not cover the cost.
Hospitals that offer this procedure will screen individuals to find out if they are eligible. The evaluation includes the person’s insurer criteria for surgery, as well as behavioral evaluation.
Will Your Health Insurance Pay for Weight Loss Surgery?
Your health insurance may pay for it. But you need to contact your insurer first. Providers have different requirements when it comes to weight loss surgery.
One of them is that you need to have a BMI of over 40. If you not, your BMI must be over 35 and you are suffering from hypertension, type 2 diabetes, and other life-threatening conditions.
You must also prove to your insurer that you have made every effort to lose weight but nothing happened. To prove it though, you need to present documented weight loss efforts.
What is the Cost of Bariatric Surgery?
The cost of bariatric surgery can be between $17,000 and $26,000. That’s why you need your health insurance to cover it.
Most people who need this surgery but their insurer denied their requests could not undergo this procedure.
Insurers deny around 25% of patients who require this surgery. If you need this surgery and you cannot pay for it on your own, then you will have to jump a few hoops to ensure that your health insurance will pay for it.
Health Insurance to Pay for Weight Loss Surgery – It May But…
In most cases, health insurance may cover this surgery. But you need to contact your insurer to know if elective weight loss surgery is included in your plan.
On the other hand, if your case is denied, you can always appeal.
Before you undergo this surgery, though, make sure that you understand your policy’s terms. You should find out whether or not obesity surgery is a part of your plan. If it is, know if you require pre-authorization.
Your health insurance plan may need medical work-up with the pre-authorization request. Furthermore, your carrier may also need documents weight-loss attempts that have been supervised by your physician.
The pre-authorization can mean volumes of paperwork. But if it is necessary, your doctors will assist you in complying with them.
Furthermore, your physician will work with your carrier just to get your request approved.
What Health Insurance Companies Cover Weight Loss Surgery?
One of the health insurance carriers that may cover bariatric surgery is Cigna. It is part of its group medical policies. Most customers of this insurer under employer-sponsored policies obtain this coverage.
Cigna has made it a standard to include obesity screening, nutritional screening, and behavioral screening. If you are eligible for this coverage, you need to meet the requirements.
Some plans have a dollar maximum, while other policies do not have any requirements. Cigna also offers a revision of past bariatric procedures. That is when the patient did not lose his appetite and has not lost weight after the procedure.
To prepare for this process, Cigna recommends that patients must schedule their regular checkups and know their BMI. They must also monitor their blood pressure and perform regular exercise.
It is also vital that patients would follow some weight loss methods to lose weight. However, these methods must be recommended by their doctors.
Some nutritionists and doctors now are recommending intermittent fasting to their patients. Intermittent fasting can help you lose weight and may prevent you from undergoing bariatric surgery.
Keep in mind that, even though this type of surgery is safe, there is always a risk you need to consider. Try intermittent fasting for about a month and see if that helps you lose weight.
However, before you try IF, make sure to insult your physician first. It is especially true if you have diabetes. If you have tried intermittent fasting and it did not work, you may wish to talk to your doctor about weight loss surgery.
Asking your health insurance to pay for weight loss surgery may require loads of paperwork. You also need to prove that you medically need it. Talk to your doctor about it so he can help you persuade your insurer to cover this surgery.
However, if your insurer denies your request, all is not lost as you can still appeal. On the other hand, you may wish to try other weight loss methods, like intermittent fasting. It is an effective way to lose weight. And if you wish extreme weight loss, you may try the OMAD or one meal a day fasting.
As always, you should talk to your doctor before you try IF. If you want to change your diet but you are not sure how to get started, you may talk to a nutritionist. I wrote an article about whether or not health insurance covers nutrition counseling or dietitian. Please click the link to read the post.