Weight-loss Surgery and Insurance
For Gastric Bypass Surgery
Gastric bypass and sleeve gastrectomy surgery usually require a two or three-day hospital stay and two to six weeks of recovery time, depending on the type of work you do. Gastric banding requires a one-day hospitalization and one to two weeks of recovery.
Many insurance companies cover bariatric surgery as a benefit, depending on the type and terms of the policy you have. Even when they are issued by the same insurance company, insurance policies may vary.
Some patients may choose to pay for the surgery on a self-pay basis. You can arrange this by calling the Wellington Surgical Reduction Center and speaking directly with the insurance coordinator. Two fees are involved: one for the surgeon and another for your hospital stay.
Determining Medical Necessity
Insurance coverage depends on whether your primary care physician, surgeon and sometimes a specialist determine that bariatric surgery is medically necessary to reduce significant medical risks to your life.
A thorough medical history, a detailed diet history for the past two consecutive years under medical supervision, current height, weight and body mass index (BMI) and a list of all co-morbidities that are or may be caused by your morbid obesity must be included in a letter of medical necessity written by your primary care physician and provided to Wellington Surgical Weight Reduction Center for submission to your insurance company. This letter, along with a psychological evaluation and clearance is a requirement for all insurance companies.
If you receive a denial of coverage by your insurance company, you should not consider this as a "definite no." In many cases, providing additional detailed information in an appeal letter will result in a denial being overturned. If your insurance carrier remains unreasonable, you may want to consider writing to your legislator or seeking legal assistance. Insurance companies will often relent to avoid confrontation. We accept many insurance plans.
Contact Us About Weight-loss Surgery
Attend one of our free monthly weight-loss surgery seminars or call 561-798-8587 to learn more about bariatric surgery.