Living a long and healthy life is what we all want to do. The road to a long life is a healthy body. To get that body, we may cut out our carbs sometimes and go out for running or do intermittent fasting from time to time. However, there are times when these techniques do not work very well in some people’s favor as they may be facing some sort of disability that does not let them exercise or have failed in supervised weight loss regimes.
Don’t lose hope if you are one of those because medical science has come up with Bariatric surgeries. However, since these are very expensive, you need to know how to get your insurance to pay for Bariatric surgery. These forms of surgery are medically proven, tried, and tested ways of losing weight, and millions of people have started living new lives thanks to them.
Not everyone has the capability of paying a lump sum amount or endure credit card debt or getting a loan approved for it. The only option many people have is to be covered by their health insurance provider for their Bariatric surgeries.
Health insurance companies do cover Bariatric surgeries, but they have laid down some conditions for the patients to undergo. You might have to jump through a few hoops.
So here’s how to get insurance to pay for bariatric surgery.
One in four applications to cover a bariatric surgery is denied due to the patient not having fulfilled some prerequisite requirements which can qualify them for it. Here are the prerequisite conditions that insurance companies demand those who need to get bariatric surgery.
You Must Really Need It
The first condition is that the surgery has been deemed medically necessary and is required to save you from further diseases. This can mean having a BMI of 40 for more than two years or having a BMI of 35 in conjunction with a disease that can lead to your death like hypertension or type 2 diabetes. Your physician can help in producing the necessary documentation regarding your health history.
Must-Have Gone Through A Supervised Weight Loss Program
The second condition that is laid down by the insurance providers is that one must have participated in a supervised weight loss program in the last two years without any significant results. This might be to gauge if you can lose your weight the natural way; however, it is also done to analyze if you can maintain a healthy lifestyle after the surgery so that no further complications may arise post-surgery.
You Must Go Through A Mental Evaluation
The third requirement is a mental evaluation to see if you understand what this surgery is for and whether you are in the right mental state to maintain and improve a healthier lifestyle post-surgery.
You Must Be Ready to Change Your Diet
The final requirement and condition are for the patient to be evaluated by a nutritional expert who will work with them to see what sort of changes can be bought into a person’s dietary lifestyle and habits.
Even though there might be some variations in the above conditions, they, however, are mostly the same across all the major insurance providers nationwide. So do your research in regards to your provider before collecting the necessary paperwork.
Your Coverage Was Denied! What Now?
Getting your insurance claim rejected for bariatric surgery will have you now jumping through some major hoops. The appeal process should be straightforward, but you might have to get yourself ready for some hefty paperwork ahead of you. You are also very short on time, as most companies give you sixty days to layout your appeal.
Write to your insurance company in an appeal letter containing a detailed explanation of why you need the surgery with an explanation request for the claim denial. Also, attach the denial circular and your doctor’s pre-authorization letter.
Once you have fulfilled all the prerequisite requirements and have proven them to your provider by providing the necessary documents, then you should be approved after the appeal.
Getting a Bariatric surgery can cost someone upwards of $25000, which many people who need it cannot afford. Your insurance provider might be the last hope in so many cases. However, you have to remain patient while dealing with all the prerequisite conditions and the required paperwork. If everything is done correctly and you fulfill all the conditions, then there should be no reason for your claim to deny.