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Insurance and Paying for Gastric Bypass Surgery

If you are a candidate for gastric bypass surgery planned, paying for the costs would definitely be a major concern for you. Typically, medical insurance will not cover full cost of such a procedure.

Get acquainted with insurance and paying for gastric bypass if you hope to have one in the near future.

Health insurance and weight loss surgery

Costs for the procedure are estimated to be between $20000 and $25000, by the NIDDK (National Institute of diabetes and digestive and kidney diseases).

There are many variables that determine whether all or part of the costs, plus any related charges will be covered by your medical insurance, like your state, the policy, your insurance company among others.

It is paramount for you to critically go over your policy or directly approach your company so as to ascertain whether this kind of procedure is covered. In some cases, procedures related to weight treatment are given explicit exclusion, meaning in such cases you would privately meet any costs right from preparation to recovery from the procedure.

Pre-authorization

You will be required to get approval from your primary care physician if you are under a health maintenance organization (HMO), before progressing to a specialist, who will either deem you a candidate for bypass surgery or not. From then you can begin the pre-authorization process.

Unlike most other procedures, the process of approval for a weight loss surgery is a little more complex. Your insurance company will most likely request for a document called ‘letter of medical necessity‘, from both your surgeon and physician.

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This is basically your medical doctors providing motivation for the surgery to the insurance company, for instance how the procedure will positively influence your overall health, or how it may avert another serious ailment which would be a risk if surgery is not done. All this is part of the pre-authorization process.

Your insurance company will either  deny or give a green-light for your pre-authorization at this point. Or they can request to be furnished with more information. Through an appeals process, you can make an appeal to whatever decision they make. It is the company’s legal obligation to make known to you your right to appeal.

Caution

Your insurance policy should clearly outline all co-costs that need to be paid privately. It is important to factor in all such costs if your surgery has been pre-approved and you have insurance cover.

Medicare

You may be able to benefit from Medicare’s benefits system if you are covered by it. Usually these are costs that are not covered by your insurance company but this is only for obesity related ailments like type 2 diabetes. In addition, the procedure has to be done at Medicare’s approved facility.

Private funding

You will have to meet your costs privately (self-pay patient) if you do not have medical insurance, or your policy doesn’t cover bypass surgery. There are options for a private lender but consider other charges related to the loan.

Flexible payment plans are offered by many hospitals enabling you to pay in instalments for services rather than paying a lump sum. Consult your doctor for an estimate of all the anticipated costs if you are a self-pay patient.

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