How do you find out if your insurance will cover gastric bypass surgery?

Question

I am not very proficient in understanding how insurance companies work. I am interested in having gastric bypass surgery. My weight has gotten out of control and I have an appointment with my physician next week. I'm sure she will be able to help, but I want to go in with as much knowledge as I can. Thanks for any answers that you can give me as far as insurance goes and anything about gastric bypass.

Answer 1

Generally speaking, insurance companies do not like to pay for bariatric surgeries, for many reasons:
1. It is much, much healthier if you lose weight the old fashioned way -- diet and exercise.
2. It is much, much cheaper for the insurance company if you lose weight the old fashioned way.
3. If you're not going to diet and exercise after the surgery, you may eventually gain weight back anyway.
4. The surgery often has lots of complications, which cause more health problems.
5. The complications also cost the insurance company more money.

So, yeah, you will have difficulty getting insurance to pay for the surgery, but if you persist, and if your doctor is willing to fight with the insurance company, you may get it paid for.

It is obvious from your well-written question that you are a very intelligent person. Please do a lot of research into this before you have major surgery.

From CBS News:
Gastric Bypass Surgery Gone Bad
Study: 1 In 50 People Die Within A Month Of Surgery
http://www.cbsnews.com/stories/2005/01/21/earlyshow/contributors/melindamurphy/main668323.shtml

From WebMD:
Is Gastric Bypass Surgery Worth the Risk?
http://www.webmd.com/content/article/77/95549.htm

Answer 2

Not sure where you are, but 3 years post-op here for Laproscopic. Had Unicare HMO at the time. I wasn't very fond of them and the requirements on other health issues (i.e. have to go to their "assigned" clinics, but when it came time for surgery I was sent to the best most experienced hospital in Chicago and treated with more compassion than I can ever have asked for from both the insurance company and the hospital staff. I was approved within 2 weeks and only had to pay the deductible for hospital stay. My suggestion would be to find a doctor that is well versed in the procedure and the staff will know how do deal with the paperwork.

Answer 3

Call the 800 number on the back of your insurance card and ask. If may cover the surgery but remember everything is billed separately, labs, office visits, anesthesia, hospital care, etc. Your doctor can probably get you a list of everything you need to take into consideration but only your insurance company can actually tell you how much it will cost you.

Answer 4

The lap band is more reliable and there's no cutting and rerouting of the intestine and you can still eat normally. I know someone who had it and has lost 90 pounds and counting and she said at least when she gets to her ideal weight she can have it removed and it won't restrict her to a permanent diet and portion of an egg. The procedure will allow less time for hospitalization and you're not as sick as someone who's had gastric bypass. Check out the lap band procedure and see if that would be a less drastic means to lose weight and the risk factors are less with this option for surgical assisted weight loss. Check with your health insurance company to see if they cover weight loss surgery. Gastric bypass is around $30,000-35,000. Lap band should be a little bit cheaper plus less complications since you get to go home within a few hours to a day not spending several days in the hospital.

Answer 5

Call your insurance company to find out what their criteria is. The doctor you are going to should also be able to tell you since this is their specialty. But a word of caution....get it in writing!!!! Have the insurance company send you a complete list of what is and is not covered.

Answer 6

you will have to call them and ask for a pre approval for the procedure. they might cover it but they might expect you to go through a class or something first. and i beleive you have to exceed 300 lbs in order to be a canidate. this is not a easy option. you can only consume less than 3oz of liquid for the first few weeks and after that well a large bite of food can basically kill you. you should try your hardest to beat this on your own. you can do it you just have to work. and if you are not willing to work then why do you deserve to lose that weight. you can do it if you want to think about that while you are going to the doc.

Answer 7

Gastric Bypass Surgery /gastrectomy/stomach stapling / lap band (all types of bariatric surgery) is very safe nowadays. It is very cheap in India. There is one company that is very famous in India that arranges obesity surgery for foreigners in India. They are called the Forerunners Healthcare. I read a lot about them in the Newspapers and about their patient stories.

I have also read that they arrange financing for American and Canadian patients, as obesity surgery is not covered by insurance. They also have photos pasted of their International patients. You can checkout their website. The cost savings are incredible. As a doctor i personally believe that your obesity surgery can be easily handled in India, as the quality of healthcare available here is simply best in the world. The surgeons are USA/UK trained and facilities are 5 star.

My cousin got her surgery for gastric bypass in India through the forerunners healthcare .She is more than very happy with the results. She has lost 65lbs in 5 months. She just paid 25% of the amount she was quoted in USA and is all praise for this forerunners healthcare company. Hope this helps.

http://www.forerunnershealthcare.com

Answer 8

Go over your insurance plan fine print with your lawyer and find out there. Also talk with your doctor and find out if he knows some "tricks" on how to deal with your insurance company.

Answer 9

Aim for a 300- to 400-calorie meal.

Answer 10

Cary a new motivational picture along