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Gastric Bypass Guide
Insurance Cover for Gastric Bypass Surgery
An increasing number of people each year are finding that their weight has reached such a level that they either choose, or are more or less forced to choose, gastric bypass surgery as the only solution to their weight problem. However, having made the decision to embark upon the road to surgery, they are faced with the problem of how to pay for the procedure.
Gastric bypass surgery, including relatively minor procedures such as gastric banding, is an expensive business requiring a highly paid surgical team, as well as a stay in hospital and you are unlikely to come away with a bill of less than $20,000 and could well be looking at closer to $30,000 or $35,000.
Indeed, if complications arise, either immediately following surgery or during recovery at home, the final bill could rise considerably higher.
The first port of call for many people is their insurance company. But will your insurance company foot the bill?
The answer will depend in the first instance upon the type of insurance policy that you have and you will need to read through the terms of the policy carefully to see whether surgery of this nature is specifically excluded and, if so, whether there are exceptions to any general exclusion. If your medical cover is being provided by your employer then you will need to seek advice from your employer, as a number of insurance companies do allow employers to specifically exclude weight loss surgery from their group policies.
This said, morbid obesity is a recognized medical condition and, more importantly, if left untreated it can become life threatening. For this reason many insurance companies will cover the cost of gastric bypass surgery as long as they are satisfied that surgery is a medical necessity.
So, if your insurance policy does not specifically exclude weight loss surgery and your insurance company says that you are not covered when you first enquire, don’t simply assume that their word is gospel. Go back to them again, preferably in writing, and make your case.
Every insurance company has its own way of doing things but, as a general rule, you will need to satisfy your insurer that this is indeed a medical necessity in your specific case, that this is the only route available to you to solve your problem and that you understand and are able to cope with the considerable lifestyle changes that result from gastric bypass surgery.
In essence this means you will normally need to provide your insurer with:
- A full medical history provided by your doctor stating his opinion that weight loss surgery is necessary. It will also help if this is supported by the opinion of a specialist in the field of weight loss surgery.
- Proof that you have attempted weight loss under medical supervision and without success in the period prior to your application. This period will vary between insurers but is typically anywhere from 6 months to 2 years. You should note that this needs to be a weight loss program under the strict supervision of a physician and that programs such as those provided by Weight Watchers will not normally be acceptable.
- A psychological report clearly indicating that you understand what is involved in weight loss surgery, including the considerable changes that it will make to your lifestyle, and that you are considered able to cope with the stress that this will inevitably involve.
Once you are able to satisfy these criteria, your insurance company will normally be happy to cover the costs of gastric bypass surgery.
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