If you are considering weight-loss surgery, you have probably spent some time wondering if your insurance will cover the procedure. Generally speaking, most insurance companies have come to understand the importance of fighting obesity. Though your insurance provider will need to ensure that you qualify for weight-loss surgery, your chances of securing coverage have improved dramatically in recent years. Even if you do not have insurance or qualify for coverage, NewHope Bariatrics has a number of options to make both the LAP-BAND? procedure and long-term weight loss an exciting - and affordable - reality.
Conditions for Coverage
When trying to determine if your insurance provider will cover weight-loss surgery, you should first refer to the information package you received when your policy coverage began. In most cases, the benefits of your insurance policy will be listed clearly under a title such as "covered expenses." If you do not have access to your insurance policy, you can simply call the customer service phone number listed on your insurance card and ask the representative if bariatric surgery is covered, and if so, what the requirements for coverage are. Please note that while and insurance companies may have plans that offer bariatric surgery coverage, often, the employer chooses whether to offer bariatric coverage as part of its specific policy. So, if your insurance is through an employer, please verify that your specific policy covers surgery for obesity. If it seems that weight-loss or bariatric surgery is not covered by your policy, pay close attention to the fine print and try to determine if there are any exceptions - such as secondary health concerns - that may qualify you for coverage.
Before your insurance provider will approve you for coverage, they will need to verify that you meet the requirements to pursue weight-loss surgery. For your insurance provider to determine that the procedure is medically necessary, you will need to submit detailed information about both your health and previous failed efforts to lose weight. Much of this information can be provided in a document known as a Letter of Medical Necessity. NewHope Bariatric physicians are very familiar with the requirements of insurance companies in determining coverage for weight-loss surgery. We will supply your insurance company with appropriate documentation and records. In this letter, the following information is usually included:
? Why weight-loss surgery is medically necessary - This section covers information about how obesity directly impacts your overall health or documentation of secondary health conditions that have been impacted by your weight to demonstrate that weight-loss surgery is the most effective treatment.
? Number of years you have been overweight - In nearly all cases, insurance providers and weight-loss surgeons will look for patients that have been overweight for at least five years.
? Body weight or body mass index (BMI) - Candidates for weight-loss surgery should be at least 100 pounds over ideal body weight, or have a BMI of at least 40. In some cases, patients with a BMI of 35 who have at least one health condition related to obesity can be candidates for weight-loss surgery.
? Obesity-related medical problems - It is important to document the presence of conditions such as type 2 diabetes, sleep apnea or hypertension as secondary medical concerns. This can help your insurance provider recognize the importance of your weight-loss surgery procedure.
? Failed weight-loss efforts - It is important that you provide as much information as possible about all failed weight loss attempts. This documentation should include an outline of your diet and exercise efforts as demonstration of your longstanding commitment to weight loss, regardless of the results. Whether the information provided comes from your own records, a commercial weight loss program or previous medical supervision, the more documentation you provide attesting to your efforts to lose weight, the greater chance you have of receiving approval from your insurance provider.
In addition to the information outlined above, you may also need to receive psychological, nutritional and/or other similar evaluations. When communicating with your insurance provider, you should also try to be very specific in describing your condition. As obesity and morbid obesity are classified as two distinct medical conditions, you want to make sure that your insurance provider understands your correct obesity classification when evaluating your claim.
How NewHope Bariatrics Can Help
As the requirements for insurance coverage can often be difficult to understand, NewHope Bariatrics is committed to help patients navigate the process. Having worked directly with numerous insurance providers, NewHope Bariatrics can assist patients in completing the necessary paperwork and assisting with the insurance authorization process. NewHope Bariatrics can also help patients determine the amount of available coverage, highlight any possible contractual agreements between NewHope Bariatrics and the insurance provider and help estimate any out-of-pocket costs. NewHope Bariatrics and our physicians will provide support in working with you and your insurance company throughout the authorization process.
If you don't have insurance or your plan doesn't cover the LAP-BAND? System, NewHope Bariatrics can also work with you to find an affordable financing program. There are several payment packages and discount opportunities available and prospective patients can take advantage of free referrals to a number of trusted lenders who are familiar with helping weight-loss surgery patients.
Whether your insurance covers the LAP-BAND? procedure or not, you will also have an opportunity to see a unique cost comparison during your financial consultation. Most people don't think they can afford to pay for LAP-BAND? surgery, but what many people don't realize is that they can hardly afford not to. The costs of living with obesity can exceed $15,000 annually! The LAP-BAND? procedure can practically pay for itself within one year. Additionally, patients without adequate insurance coverage can also take advantage of potential tax deductions, bringing the total cost down even further.
As the LAP-BAND? is regarded as both the most affordable and lowest risk weight-loss surgery, the benefits of the procedure far outweigh the costs for most patients. Though your chances of receiving insurance approval will be contingent on the requirements of your provider, there are many funding options available to prospective patients. As obesity takes such a great toll on life - both physically and financially - the LAP-BAND? procedure can represent an incredible opportunity for all qualified individuals.
As with any medical surgical operation, there are clear and present risks of health complications. Therefore when one is considering a weight loss surgical option, it should be the last resort to lose weight when every other method with professional instruction such as dieting and exercising has failed.
You should definitely try to lose weight with other methods first such being on an exercise and healthy dieting program. If you do not know how to start, then engage a qualified fitness instructor if you need someone to teach, motivate and push you towards your weight loss goals.
Your fitness personal trainer will not only guide you through your exercises and workouts, he or she will also plan a proper eating program for you and at the same time, monitor weight loss progress professionally.
You must need to be aware that even with a successful weight loss surgery and you continue with your bad eating habits and do not do regular exercises, the weight you have lost may very likely to return to haunt you.
This can be rather distressful after so much money is spent and the ordeal of undergoing a surgeon's knife. Therefore a weight maintenance program is very crucial for your long term success.
When, all else fail which is unlikely, and then it may be plausible to go under the surgeon's knife for the surgical procedure. There are issues to consider if you opt for weight loss surgery or in medical term, a bariatric surgery.
You should be least 100 pounds overweight or your BMI (body mass index) is 40 and above. You may also have hypertension, diabetes, or sleep apnea and have tried to lose weight unsuccessfully using other methods.
However, a weight loss surgery is not recommended if you are suffering from psychiatric effects, drug and alcohol addiction, medical conditions that may contraindicate the surgery and or having unreasonable expectations.
Also, you must understand that you are undergoing the surgery for yourself and for your health. If you and your spouse are having problems and you think that surgical option will make your spouse love you more, then the surgery definitely not for you.
Another example will be that you want to attract somebody else and think that a slimmer post surgery will make you more attractive to the person you like, then again, this is not for you because you may suffer from bad surgery psychological effect when you fail to attract that person.
Before your surgery, extensive medical and psychological testing will be conducted by your plastic surgeon to determine if a meet the medical guidelines and is a good candidate for a successful weight loss surgery.
Do research the subject extensively and consult your plastic surgeon or even a psychologist before you come to an informed decision to undergo a weight loss surgery.
Both Carole S. Guinane & Chrischew are contributors for EditorialToday. The above articles have been edited for relevancy and timeliness. All write-ups, reviews, tips and guides published by EditorialToday.com and its partners or affiliates are for informational purposes only. They should not be used for any legal or any other type of advice. We do not endorse any author, contributor, writer or article posted by our team.
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