Insurance Options and Questions

Paying for Surgery

For many people, bariatric surgery is affordable because it is covered by their health insurance plan. People who do not have insurance coverage for bariatric surgery must pay for it on their own. This is called self-pay or cash-pay. Some patients pay for their own surgery and consider it a critical investment in their health.

Working With Health Insurance
Many people find dealing with health insurance companies to be intimidating and are not sure how to even get started. If your bariatric surgeon recommends surgery, consider the following:

Your best resource for how to deal with your health insurance company may be your bariatric surgery program. We may already have experience working with your health insurance company and may be able to make the process easier for you.

Read your Certificate of Coverage (COC). A COC describes your insurance policy in detail, including what it covers and what it excludes.

Write down your weight loss history. Go as far back as you can and include diets and exercise programs. If possible, pull together receipts for gym memberships and weight loss programs. Only include diet programs that include face-to-face contact with a doctor, dietitian, or utilize a structured program that require weekly/monthly weigh-ins.

Appealing a Denial
If the insurance company turns down your request for bariatric surgery, you may be able to appeal the decision. Many people do not take advantage of the appeals process or know of the laws that govern insurance companies in their state. We may be able to file an appeal on your behalf, or may be able to assist you in filing your own appeal.

What if Bariatric Surgery is not a Covered Benefit?

Health insurance is one of the most common benefits offered by employers. Large employers often have self-funded health insurance and decide which health services and procedures are covered under their policy.

If this is the case, there are steps you can take if your employer has decided not to include bariatric surgery as a covered benefit.

Meet With a Human Resources Representative
Take time to meet with someone from Human Resources to find out why bariatric surgery is not covered. Share your story and how you believe bariatric surgery will benefit not only you, but your organization as well.

It may be helpful to bring information about the many benefits of bariatric surgery—such as increased energy levels and decreased health issues — which can translate into savings for the employer.