What can I do if my insurance is denied bariatric surgery?

What can I do if my insurance doesn’t cover bariatric surgery?

If your insurance does not provide coverage for bariatric surgery, there are other options available to you. Depending on plan language, consultations, nutritional counseling and pre- and post-operative tests, labs and follow-up visits may be covered, although surgery is not.

How can I get my insurance to pay for gastric sleeve?

To prove to your insurance company that your surgery is medically necessary, following are the typical steps:

  1. Minimum body mass index (BMI) requirements to be confirmed by your physician: …
  2. Complete a medically supervised diet program. …
  3. Schedule a consultation with your bariatric surgeon.

Can I get bariatric surgery without insurance?

Gastric sleeve or sleeve gastrectomy and other forms of weight loss surgery including lap bands, gastric bypass, tube gastrectomy, are not commonly available in the public hospital system. Therefore, without health insurance, you must fund your surgery in the private hospital system.

What can disqualify you from bariatric surgery?

These are as follows:

  • Drug and/or alcohol addiction.
  • Age under 16 or over 75.
  • History of heart disease or severe lung problems. …
  • Chronic pancreatitis (or have a history of this).
  • Cirrhosis of the liver.
  • Autoimmune disease such as systemic lupus erthyematosus.
  • Blood disorder which increases your risk of heavy bleeding.
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How do I convince my doctor I need bariatric surgery?

Ask your primary-care doctor or gynecologist for a referral to a weight loss surgeon. They’ll likely have patients who have undergone weight loss surgery, seen their success, and can help guide your choice of surgeon.

How do you get approved for bariatric surgery?

Bariatric Surgery Requirements

  1. Have a body mass index (BMI) of 40 or higher, or have a BMI between 35 and 40 and an obesity-related condition, such as heart disease, diabetes, high blood pressure or severe sleep apnea.
  2. Weigh less than 450 pounds, the maximum weight that hospital radiology equipment can accommodate.

Who is eligible for gastric sleeve?

The minimum requirements to qualify for gastric sleeve surgery include: A body mass index (BMI) of 40 or more, OR. A BMI between 30 and 39.9 with a serious obesity-related health problem like diabetes, high blood pressure, sleep apnea, high cholesterol, joint problems, and many others.

How much does gastric sleeve cost out of pocket?

The average cost of gastric bypass surgery is $23,000, the average cost of lap band is $14,500, and the average cost of sleeve gastrectomy surgery is $14,900.

Why was bariatric surgery denied?

While some patients may be denied coverage due to a clerical error or a technicality which can be overturned, other patients may not be deemed candidates for bariatric surgery by their insurance company and therefore not have coverage.

How do I qualify for free weight loss surgery?

To be eligible for the Subsidised Bariatric Program you must meet specific requirements including being a resident of NSW, having a BMI of at least 40, as well as major and proven medical problems such as Type 2 Diabetes, sleep apnoea, NASH (severe fatty liver), major structural joint pain (referred from orthopaedic …

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What is the cheapest gastric surgery?

Gastric bypass is tied for the lowest-cost procedure if you have insurance that covers bariatric surgery. Without insurance, it has the 6th lowest average total cost.

How long is the waiting list for bariatric surgery?

Each PCT (Primary Care Trust) has a different waiting list, so it is important to do some research or ask them directly what is the waiting time for bariatric patients – it may be 2 months or even 2 years.