For those that qualify for the procedure known as gastric bypass surgery, a top priority is how to pay for such an operation. In some instances, medical insurance won’t pay for even half or the entire amount, in terms of cost, for this type of operation. The following information will provide a detailed analysis of insurance and gastric bypass surgery.
The Issue of Health Insurance and Gastric Bypass Surgery
Gastric Bypass surgery typically costs on average between $25 000 to $20 000, a figure according to the National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK). Paying for such an expensive procedure can be a concern, understandably. And whether or not this operation as well as the related costs are covered by health insurance depends largely on your insurance company, your specific policy and the state where you reside.
Discuss your specific policy with whomever you are insured with so as to see if you are properly covered or not. In some instances a given insurance policy will not cover Gastric Bypass Surgery and the ensuing required care. By this they mean they will not pay for costs related to the preparation, actual surgery and recovery period following surgery.
The Process of Pre authorization
For those that are insured by an HMO, you will be required to get your general practitioner or family physician to refer you to a bariatric surgeon. They specialize in weight loss surgery. Upon seeing a bariatric surgeon, and qualifying as a good candidate for such a surgery, the next step is the pre authorization process.
The actual steps it takes to get approval for such a procedure can be rather precarious compared to that of other more popular medical procedures. In most cases your insurance company will insist on having your family general practitioner and bariatric surgeon send what is called a “letter of medical necessity.” This is the first initial step in the pre authorization process. In this letter both your general practitioner and surgeon should stipulate how your overall health and physical constitution will be much better by having this procedure.
At this point, your request for authorization will either be approved, denied, or you will be required to send to your insurance company more information. Typically what then ensues is that your doctor and surgeon will either have to send in additional information, by calling, faxing or mailing this specific and required data.
You do have the opportunity to appeal an insurance company’s decision if they choose to deny you coverage. Most if not all insurance policies are by law required to let you know of your right of appeal. Typically you have 30 to 60 days.
A Caveat
Those pre approved and covered by insurance must be aware of any co pays or co insurance costs they will personally have to pay.
Medicare Coverage
Medicare will cover some of the costs of gastric bypass surgery, but only if you are overweight and suffer from type 2 diabetes and or heart disease.
Self Pay Patients
If you have no coverage, you will be forced to pay for the surgery yourself. Some hospitals do offer payment plans, so you will not have to pay all at once. There is also the option of obtaining a personal loan from a reputable financial lender.
The Overall Cost
If you choose to pay for gastric bypass surgery with the help of a private lender take into consideration the numerous expenses involved, such as the surgeon bill, cost of anesthesia, and nutritional consultations. Your physician should be able to explain what is involved and the cost.
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