Top 5 Questions to Ask Your Insurance Company

As you read in the payment options section of this website, there are intricacies to financing your procedure through your insurance plan. If you have a private insurance plan, you may want to call your provider and ask the following questions about your plan for bariatric surgery and more:

1. Does my policy cover bariatric surgery?

Not every policy covers bariatrics, and even if your insurance company does, your particular plan may not. Does my policy cover all forms of surgery, and if not, which procedures are covered?

2. What are my co-pays and deductibles and when does my deductible reset for the year?

Your deductible will reset every year, either at the end of the year or on your policy anniversary.

3. What are the Requirements for Coverage?

Most policies have specific guidelines for when surgery is covered. Knowing what is required of you is important.

4. What information do I need to provide to obtain a pre-authorization for coverage?

Prior authorization may include documentation of failed diets, including medically supervised diet plans. It may also require you to submit documentation of specific tests completed prior to surgery. This process and the requirements for coverage vary between insurance carriers and policies.

If you intend to use Medicare to cover your bariatric procedure, be advised that they do not have a pre-authorization system. You will not know if you are covered until after the procedure.  In addition, your surgeon may ask you to sign a payment guarantee in case Medicare denies your claim. Be sure to ask Medicare to provide a list of requirements for coverage, and before surgery, verify with your surgeon’s office that you have met all of those stipulations.

5. What is the Denial Appeal Process?

If your pre-authorization is denied ask your insurance company about your appeal options. Insurance companies must have a process in place to allow you to appeal their decision.

If you have more questions about using your insurance coverage for weight loss surgery, please contact our office staff.