Weight loss surgeries are becoming more common, and more and more
people are in need of them; however not all insurance plans cover the
costs associated with these types of surgeries. One of the first things
that you should do is contact your insurance provider. They will be able
to inform you whether or not the surgery you are in need of is covered.
Many times insurance companies will not list these particular surgeries
on their list of covered procedures. This is done in an effort to
reduce or avoid paying these types of claims.
The next step anyone who has been issued an exclusion is to have their doctor write a letter stating that the surgery is of medical necessity. This letter will be required for any appeal to be properly filed. The letter written by your doctor should include your current weight, how long you have been morbidly obese and any medical conditions that have resulted because of your weight. To be considered for surgery patients must be morbidly obese, which is defined as anyone having a BMI greater than 40. A BMI, or body mass index, is determined by the patient's height in comparison to the patient's weight.
You should also include a list of all of the weight loss programs and regimens you have tried and not been successful at. Include all of the available information for any commercial weight loss programs that you participated in. This will help show the appeals board that you are seriously trying to lose the weight, but all of your attempts have been futile. These documents will also show that you have done everything within your power to lose the extra weight in the past.
Once you have gathered all of the required information, you should then mail all of the documentation to your insurance company. When mailing these documents to your insurance provider, you should send them using delivery confirmation or require a signature to ensure that they have properly been delivered and accepted. This should be done to provide you with some proof in case the insurance company states that they did not receive the documentation.
When you receive any correspondence from the insurance company asking for more information or documentation, it is important that you reply immediately. If you continue to receive denials from your insurance company, you should continue to file appeals. Many insurance companies will continually deny your claim hoping that you will give up and eventually switch carriers. Do not allow them to discourage your or intimidate you, persistence often pays off.
The next step anyone who has been issued an exclusion is to have their doctor write a letter stating that the surgery is of medical necessity. This letter will be required for any appeal to be properly filed. The letter written by your doctor should include your current weight, how long you have been morbidly obese and any medical conditions that have resulted because of your weight. To be considered for surgery patients must be morbidly obese, which is defined as anyone having a BMI greater than 40. A BMI, or body mass index, is determined by the patient's height in comparison to the patient's weight.
You should also include a list of all of the weight loss programs and regimens you have tried and not been successful at. Include all of the available information for any commercial weight loss programs that you participated in. This will help show the appeals board that you are seriously trying to lose the weight, but all of your attempts have been futile. These documents will also show that you have done everything within your power to lose the extra weight in the past.
Once you have gathered all of the required information, you should then mail all of the documentation to your insurance company. When mailing these documents to your insurance provider, you should send them using delivery confirmation or require a signature to ensure that they have properly been delivered and accepted. This should be done to provide you with some proof in case the insurance company states that they did not receive the documentation.
When you receive any correspondence from the insurance company asking for more information or documentation, it is important that you reply immediately. If you continue to receive denials from your insurance company, you should continue to file appeals. Many insurance companies will continually deny your claim hoping that you will give up and eventually switch carriers. Do not allow them to discourage your or intimidate you, persistence often pays off.
Nina Mehrabani is a Health care Coordinator for One Stop Med
Center located in sunny Mexico where high quality care and affordable
cosmetic surgery is their priority. To learn more on this topic and
other various cosmetic surgery procedures, please visit One Stop Med Center
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