Health Insurance and Gastric Bypass Surgery

Gastric bypass surgery today costs from $20,000 to $25,000 at the most. Health insurance company’s views on such medical procedures greatly differ and vary, so if you ever you plan to undergo a gastric bypass surgery be sure to check and review you insurance policy carefully, or ask your insurance underwriter to determine your status on this. Most insurance plans exclude treatments for obesity, weight loss surgery and related treatments, so you will not get reimbursed for any charges you incurred before and after undergoing the surgical procedure.

Pre-Qualifying Process

If the patient’s insurance company has a contract with an HMO of which they are actively enrolled in, then they can get approval from the primary care physician and then be referred to a Bariatric specialist who will perform the weight reduction surgery. Once approved for the procedure, then the pre-qualifying process will be initiated.

If your request is approved, you still need to remember to include clauses for co-payment or co-insurance costs that will need to be paid out of your own funds. Again, check carefully if this is within the scope of your health insurance policy.

If you are denied by your insurance company, you can still appeal the decision with additional follow-ups with your doctors, supporting documents, or other important information asks by your insurer. The grace period to complete such requirements is from 30 to 60 days from the date of denial.

Medicare Coverage

With a Medicare coverage, the portion of the surgical costs and other related care may be covered – but only if you are obese and suffering its health related complications such as coronary heart disease, sleep apnea, hypertension, high blood pressure, type 2 diabetes, lower back and joint pain. Medicare does not cover gastric bypass surgery for overweight patients not suffering any health related problems, even if they are certified by a physician as being obese.

There are numerous types of supplemental insurance. Supplemental insurance essentially works to pay most of what your insurance doesn’t cover. Different types of supplemental insurance have different stipulations.

For example, there are supplemental insurance companies which are geared towards women planning on having babies. The catch is that you must have the insurance several months before becoming pregnant. Then, when the bills come, the supplemental insurance will generally cover what primary insurance does not, and sometimes it will even give cash benefits.

Before getting involved with any supplemental insurance companies, do your research. Do a little research to find out if the company has good reviews. Make sure that you sign up for the insurance with enough time in advance before your surgery. The company wants to avoid paying out any money, which means they often will not cover major operations unless you have held the supplemental insurance for the minimum amount of time.

Also, when you begin filling out all the paperwork, be sure you dot all your “i”s and cross all your “t”s, so to speak. If you leave anything out at the time of application you may not get the coverage you seek at the time of your surgery.

As you pursue having gastric bypass surgery, keep in mind that even if you are unable to find a supplemental insurance policy, most primary insurance policies will cover the costs of your surgery.

As most uninsured people will tell you, this is often a costly way to have health insurance. Rates are determined based on existing health conditions and health risks. However, if you can find a health insurance plan that will cover you AND that will cover gastric bypass surgery (or other similar weight loss surgery), it is worth almost anything they charge you.

On average, gastric bypass surgery costs $20,000-$25,000. That is the average. If you have any complications, that cost may be even higher. If you are like most people, you simply do not have that sort of money to spend. However, if you can get insurance to cover the cost, then it might be well worth it for you to pay the high rates and high deductibles that you get with a mediocre insurance plan.

If you cannot get insurance to cover the costs, some hospitals will allow you to work out a payment plan. You will pay for the surgery with interest- the same way you would pay off a car or house. That would mean your total cost of surgery would actually be much higher than the average.

You’ll need to do the math. How much are you willing to spend to be thin and possibly rid yourself of the health problems associated with obesity? Some people would be willing to pay anything. Other people would be content to remain overweight- for various reasons.

If you can find an insurance plan that will cover gastric bypass surgery, you should look into it. As long as the annual costs of the insurance plan is less than the surgery, then it is probably worthwhile for you to buy the health insurance.

Every situation is unique, and you’ll need to find what works for you. Be smart, though. And do the math.

It can still be very beneficial to get insurance. These days, surgery may not even cost you one red cent with health insurance. That said, costs can vary widely from state to state. Among other factors it depends on your insurance company and your specific policy.

Your insurance company may have a couple of prerequisites, though, before it will cover the gastric bypass cost. These prerequisites may include such things as a complete medical physical, a “letter of necessity” from your doctor and your bariatric surgeon stating that this surgery will benefit your well being and standard of living.

If you get denied the surgery, then you generally have 30 to 60 days to appeal the decision. This process can be frustrating but if you are serious about the surgery then you may very well have to face this obstacle. Those who persevere in life usually are those who achieve their goals!

In some ways, it might be best to let these sorts of professionals handle these things because they are well-trained in jumping through the insurance hoops, and they know what buttons to push to get your gastric bypass complications covered by insurance.

The title of this post is a difficult question to answer. In short- sometimes. Everything depends on your current coverage, your current state of health, how adept you and your doctors are at working with insurance companies among other factors.

Insurance plans vary greatly. When it all boils down to it insurance companies are there to make money. That means many companies will do whatever possible to avoid covering expenses. Because of that, it is key that as the owner of the policy you convince the insurance agents that the gastric bypass surgery will be cheaper than the costs of treating any other obesity-related illnesses you may have currently or may experience in the future.

Generally surgeons will only perform the surgery on patients who are termed “morbidly obese.” To have the surgery done on a patient that is not morbidly obese, is often considered “elective surgery” which is viewed by insurance companies as optional. An example of “elective surgery” is plastic surgery like rhinoplasty (nose job).

Because patients usually need to be “morbidly obese” to qualify for the surgery to begin with, it generally means those patients also have other health problems like diabetes, high cholesterol, heart disease and heart failure, high blood pressure, sleep apnea, chronic acid reflux, gallbladder disease, liver disease, blood clots, back problems and joint problems.

The trick, then, is to convince the insurance company that it is cheaper to cover the cost of gastric bypass surgery than to cover all the other obesity-related illnesses.

Unfortunately, some insurance policies simply won’t cover gastric bypass surgery. Any policy that has an “exclusion” written into it for gastric bypass surgery or lap band surgery simply will not cover either procedure. If your insurance policy has such an inclusion you have a few options.

• You might be able to change your policy or upgrade your policy at your company’s open enrolment date.
• If you are married, and your spouse works, you may be able to switch to his/her policy. In the short term, this is very likely the more expensive option, but it is probably cheaper than paying for the surgery outright.
• Some bariatric surgeons will work with you to pay for the surgery out of pocket.

If you are on Medicaid or Medicare, it is unlikely that you will be covered. Since Medicaid simply does not cover any sort of weight loss surgery. Medicare will cover the surgery if there are other serious illnesses caused by obesity.