Insurance Tips for Bariatric Surgery

doctor and patient examining insurance policy at desk

When we think of any surgery, particularly bariatric surgery, we may wonder how to pay for it. Bariatric surgery is the only long-term proven solution for obesity, a disease that has reached pandemic status yet remains woefully under-treated. As a matter of policy, many people, even insurance companies, still consider it an elective procedure. As such, the insurance process is not as straightforward as other essential medical coverages, and some insurance companies do not cover bariatric surgery at all. One of the most significant barriers to bariatric surgery adoption is the insurance process and the paperwork required for a pre-authorization. While we try to guide our patients through the process as best we can, most of the work ultimately relies on them getting their medical clearances quickly and filling out their paperwork accurately.

To help, we have developed these five tips to make the insurance process more accessible and remove some uncertainty from what is otherwise a very exciting and hopeful journey.

Step 1: Prepare, prepare, prepare – preparation is the key to making the bariatric surgery insurance process as smooth as possible. First and most importantly, you need to make sure you have coverage. This can be done by calling our office to verify benefits and speaking to the insurance company to understand all the requirements and stipulations for coverage. Once you have your requirements, you can move on to the next stage of your journey: assemble this documentation for submission to insurance.

Step 2: You will need several medical clearances, and likely need to complete other requirements like a medical weight loss program. Cardiovascular, psychological, and other clearances can be scheduled through our office and are typically covered by insurance. We can also help you find appropriate medical resources that we have worked with in the past and know to be reliable. Get these scheduled sooner than later. Medical offices are busy, and wait times are higher than ever. You may wish to consider urgent care and trustworthy online care resources if your PCP can’t fit you in anytime soon.

Step 3: There are several preoperative requirements, and it’s easy to get distracted by other life events. Keep in touch with our office, especially after you have undergone the appropriate testing or if you have any questions. We help hundreds of patients through this process each year and are happy to guide you. Don’t feel like you must go at it alone; don’t think you are bothering us with your questions.

Step 4: Double and triple-check your documentation. You’ll likely have a checklist of items that are required for pre-authorization. Once you’ve compiled all those documents and tests, be sure that you double-check them for accuracy. Even the slightest typo or clerical error can cause a pre-authorization denial on technical grounds. Why deal with re-submission and delays when you can get it done the first time around?

Lastly, in case of an insurance rejection, don’t worry. We have a pretty good idea of when a patient should qualify – most denials are because of a technical oversight or clerical error. These can be corrected by calling the insurance company and getting the decision in writing. We can then work with you to understand why the pre-authorization or claim was denied and submit the appropriate paperwork in a resubmission. If your claim is rejected repeatedly, you always have recourse with an appeal or even getting the state of Texas involved. Our office has done dozens of appeals and we often figure out the rejection very quickly in the process. We will work aggressively to help you get your surgery.

Of course, there are times when you simply don’t have insurance coverage or the insurance company does not believe that bariatric surgery is a medical necessity. In these cases, patients can finance or pay cash for the procedure, and Dr. Chang has negotiated some of the best cash pay rates in the nation at $8,999 for a gastric sleeve. We encourage you to contact our office to learn more about your financial obligations if you take advantage of this special program; of course, if you have insurance coverage, feel free to contact our experienced intake specialists, who can guide you through the steps to surgery.