Gastric Bypass Insurance Coverage

Do you know if you have gastric bypass insurance coverage?

Weight loss surgeries costs $25,000 to $35,000, on average. Unfortunately, in the past many insurance companies have decided not to provide gastric bypass surgery coverage, or to cover mini gastric bypass or lap band procedures. They based their decisions on statistics, believing that  the surgery itself and the cost of covering side effects and complications cost them millions that they could not afford.

Fortunately, bariatric surgery has improved dramatically in the past few years. It has become safer and more successful, and more and more insurance policies are covering it.

Gastric bypass insurance coverage – your doctor may be able to help

Some times, if your surgery is denied, your doctor or doctor’s billing department can find ways around the denial, but only if there is no specific exclusion for gastric bypass insurance coverage in your policy. A simple letter from your doctor explaining what the risks to your health are can sometimes get your surgery covered if the policy allows. Appeal letters to the insurance company with additional information included also can sometimes reverse the insurance provider’s decision.

Unfortunately, a letter from your doctor, and appeals to your insurance company or insurance commissioner in your state won’t help if your policy has a specific exclusion clause for gastric bypass insurance coverage. If there is an exclusion clause that states they will not cover bariatric surgeries, there is no loop hole to bypass that because the policy is a contract – the insurance company is not required to pay for anything the contract specifically excludes.

If you want to have the gastric bypass surgery and your insurance doesn’t cover it, you may be able to add yourself you your spouse’s insurance policy. Since this will probably add to your monthly insurance cost, be sure the other insurance doesn’t have the same exclusion to bariatric bypass surgery written into it, and be sure to check to any waiting periods that may be required before gastric bypass is covered. Also check the fine print to see if they’ve hidden the exclusion for gastric bypass insurance coverage under the “elective procedures” clause.

What to do when you don’t have gastric bypass insurance coverage

Uninsured patients will need to find another source of funds if the weight loss surgery is not covered by their insurance. Uninsured patients have charged their surgeries on credit cards, refinanced their homes, and have even taken out loans to cover the cost so they can lose the excess weight and become healthier. They state it is well worth the cost to once again play with their children and be rid of health problems such as aches and pains, diabetes, or high blood pressure. They say their self esteem has improved and for the first time in years they feel good about themselves.

Be sure to have a frank conversation with your insurance company representative to find out whether or not your weight loss surgery is covered. With the situation improving all the time, it is now easier than ever before to find gastric bypass insurance – but don’t take anything for granted.