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Over
the last few years, more and more insurance companies cover bariatric
surgery for the treatment of morbid obesity. This is due to the realization that
morbid obesity is a disease, and that conventional weight loss is ineffective.
The surgery has been shown to be effective in alleviating co-morbidities such
as hypertension, type II diabetes (adult onset), sleep apnea, high cholesterol/lipids,
polycystic ovary syndrome, respiratory compromise, and cardiac disease. Although
the National Institute of Health endorsed bariatric surgery for the treatment
of morbid obesity in 1991 with a set of criteria, most insurance companies have
their own set of criteria that must be met in order for the surgery to be deemed
"medically necessary."
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Criteria Most Insurance Companies Require
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A body mass
index (BMI) of 40 or greater, or between 35 and 40 with life threatening co-morbidities,
or 100 pounds or more over the ideal body weight. -
Medically
supervised weight loss history records for the past year (actual records/notes
from the physician). All insurance companies require 6 consecutive months of at
least one medically supervised weight loss program with your primary physician,
within the last 2 years. Your insurance company will require monthly weigh-ins
within that 6 months as well. -
Letter
from primary care physician including a strong statement recommending surgery
as the last resort for the patient to treat their medical conditions because all
other weight loss efforts have failed. -
A
psychological clearance from a psychiatrist or psychologist. -
Recent photographs. |
Your
insurance company may request any of the above mentioned criteria. Although the
letter sent to the insurance companies generally establishes medical necessity,
surgery is still considered an elective procedure. Some insurance companies do
not cover the surgery regardless of any documentation of the above mentioned facts.
The best way to determine if your insurance company will pay for bariatric surgery
is to check your benefits booklet. If you cannot locate your booklet, or do not
have one, you may contact your insurance company by phone. A representative would
be able to help you with this.
Contact Ellen for finance and insurance information, she will
assist you in obtaining insurance approval for your surgery. Click
here to email Ellen.
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