All Topics > Health > Insurance Approval for Weight Loss Surgery >

Insurance Approval for Weight Loss Surgery California

Acquiring insurance coverage for weight loss surgery can be a major obstacle to finally achieving a healthier body and life.

Local Companies

UnitedHealthcare
(925) 602-1615
2300 Clayton Rd., Ste. 1000
Concord, CA

Stephen J. Giovanisci, D.D.S., Inc.
(818) 248-1718
2103 Montrose Ave., #A
Glendale, CA

Patrick Mazzei, DDS
(559) 432-6474
6335 N. Fresno St. Ste #104
Fresno, CA

Nathan E. Vick, DDS
(559) 439-1245
6215 N. Fresno St., Ste 101
Fresno, CA

White & Bright Family Dental
(559) 432-6384
6073 N. Fresno Street, Suite 103
Fresno, CA

Fresno Madera Dental Society
(559) 438-7284
371 E. Bullard, #120
Fresno, CA

Supplemental Health Care
(5) 592-2463
575 E. Alluvial #110
Fresno, CA

Delta Dental of CA
(559) 283-5775
P.O. Box 3525
Pinedale, CA

John F. Williamson Insurance Services
(559) 243-1833
5070 N Sixth St #187
Fresno, CA

Kubo Orthodontic Group
(559) 438-7600
6315 N. Fresno St., #101
Fresno, CA

Adapted From: Weight Loss Surgery For Dummies

One of the happier moments in your weight loss surgery journey is when you get the seal of approval from your insurance company.

Most insurance companies realize the long-term effects and cost savings associated with the weight loss that occurs after patients have weight loss surgery. For example, if you have diabetes, your insurance company will spend thousands of dollars covering your medications and treatment. Paying for one gastric bypass procedure is likely less expensive for the insurance company than paying for your diabetes medications and treatment for the rest of your life (not to mention paying for any other complications that may arise down the road as a result of your obesity).

Unfortunately, obtaining insurance approval is not always easy. Acquiring insurance coverage for weight loss surgery can be a major obstacle to finally achieving a healthier body and life. Over the past few years, insurance carriers have seen a significant increase in the demand for weight loss surgery procedures. According to the American Society for Bariatric Surgery (ASBS), 16,200 weight loss procedures were performed in 1994. Ten years later, in 2004, an estimated 140,640 surgeries were projected to take place — that's more than an 800 percent increase! The average cost for surgery is now approximately $25,000. Due to this increase in procedures and cost, some insurance companies are making it more difficult for patients to obtain approval. These insurance companies don't view their policyholders as long-term responsibilities and figure their customers will switch carriers before they can recoup their investment.

So what hurdles will you have to cross? Most companies require what's called a letter of medical necessity from your bariatric surgeon and your primary-care physician. The following information is generally what's required in this preauthorization letter:

Your height, weight history, and body mass index (BMI)

A description of your obesity-related health conditions, including records of treatment

A detailed description of the limitations your obesity places on your daily activities

A detailed history of the results of your dieting efforts, including medically- and non-medically-supervised programs

A history of exercise programs, including receipts for memberships in health clubs

Ask your doctor to include information from medical journals regarding the effectiveness of weight loss surgery, especially information demonstrating the control or elimination of obesity-related health conditions.

Many carriers also require a nutritional consult and psychological evaluation. Your surgeon will take care of referring you for these consultations.

A number of carriers now require detailed documentation of participation in a physician-supervised diet. Most require the submission of at least six months' worth of office notes from the supervising physician, including proof of dietary supervision and recorded weigh-ins.

Not all primary-care physicians support weight loss surgery. Your physician may not be up to speed on the latest techniques and safety reports; he may only be familiar with older procedures that had higher risks. Don't be discouraged. You can bring information to your doctor to try to change his opinion. If your primary-care physician cannot be persuaded, you may have to find another primary-care doctor who understands the necessity for your surgery.

Request letters and documentation from any medical professionals who treated you for health-related conditions caused by or aggravated by obesity. Make sure all the letters are sent directly to you (as opposed to your doctor's office), so you can determine if they're supportive of your case. Be sure to make copies of the letters for your records. In addition, forward to your surgeon anything that documents difficulties related to morbid obesity such as:

High blood pressure

Diabetes

Cardiovascular disease

Sleep apnea

Gastroesophageal reflux

Infertility

Arthritis

Dyslipidemia (a disease characterized by a high concentration of lipids and cholesterol in the blood; a risk factor for heart disease and cardiovascular disease)

Urinary stress incontinence

Other obesity-related conditions

Other important information to provide your surgeon includes

Your weight history, demonstrating a history of morbid obesity

Your current medications

Your psychiatric history

Your musculoskeletal history, like joint pain, bone fractures, and osteoarthritis

Any allergies you have

Each weight loss surgeon's practice has its own way of managing financial and insurance issues. Someone in the office should be able speak to you about your insurance concerns and questions. Most of these advisors are familiar with the ins and outs of working with specific carriers.

Being familiar with your own policy is still important. Even the most well-informed advisor won't know all the details of your specific policy without some investigation.

provided by:

For Dummies is a registered trademark of Wiley Publishing, Inc. in the United States and other countries. Used here by license.

Featured Local Company

UnitedHealthcare

(925) 602-1615
2300 Clayton Rd., Ste. 1000
Concord, CA

Read more about Insurance Approval for Weight Loss Surgery

- Cosmetic Surgery California

Face-lifts, arm lifts, breast implants, rhinoplasty, plastics, etc. If you're considering cosmetic surgery you're probably overwelmed by all the information available. This site will quickly cover the basics including the requirements, costs, risks and personal implications of cosmetic surgery.

- Facelift California
- Breast Implant California
- Male Breast Reduction California
- Tummy Tuck California
- Arm Lift California
- Thigh Lift California
- Lasik Eye Surgery California
- Tooth Whitening California
- Breast Reduction California

Regional Articles

- Thigh Lift California

If you have an excess of skin in your thigh area, you may be considering a thigh lift. Known as a thighplasty, this cosmetic surgery can significantly improve what often happens to your thighs as a result of significant weight loss.

- Breast Reduction California
- Facelift California
- Lasik Eye Surgery California
- Male Breast Reduction California
- Tooth Whitening California
- Tummy Tuck California
- Cosmetic Surgery California
- Breast Implant California
- Arm Lift California

Related Local Events

LABAUTOMATION 2010
Dates: 1/23/2010 - 1/27/2010
Location: Palm Springs Convention Center
Palm Springs, CA
View Details

Medical Design & Manufacturing West (MD&M West)
Dates: 2/8/2010 - 2/11/2010
Location: Anaheim Convention Center, Anaheim
Anaheim, CA
View Details

Medical Imaging
Dates: 2/13/2010 - 2/18/2010
Location: Town & Country Resort & Convention Center
San Diego, CA
View Details

Medical Aesthetics Conference & Expo Los Angeles
Dates: 2/20/2010 - 2/21/2010
Location: Los Angeles Convention Center
Los Angeles, CA
View Details

Supply Expo
Dates: 3/11/2010 - 3/14/2010
Location: Anaheim Convention Center
Anaheim, CA
View Details

Advertising	Food & Beverage	Nightlife
Business Services	Franchise	Online Database
Career	Health	Pets
Cars	Holidays	Real Estate Resources
Computer Hardware	Home Appliances	Retail & Consumer Services
Construction	Home Electronics	Software
Education	Home Services	Technology
Entertainment	Industrial Goods & Services	Telecommunications
Environmental	Insurance	Trade Shows
Family	Internet	Travel
Fashion	Legal	Weddings
Financial Services	Miscellaneous	World History

Advertising	Family	Home Services	Real Estate Resources
Business Services	Fashion	Industrial Goods & Services	Retail & Consumer Services
Career	Financial Services	Insurance	Software
Cars	Food & Beverage	Internet	Technology
Computer Hardware	Franchise	Legal	Telecommunications
Construction	Health	Miscellaneous	Trade Shows
Education	Holidays	Nightlife	Travel
Entertainment	Home Appliances	Online Database	Weddings
Environmental	Home Electronics	Pets	World History