Health Insurance Approval for Bariatric Surgery
Gastric bypass surgery is becoming increasingly popular and health insurance companies are carefully scrutinizing those seeking approval for the procedure, said Gus J. Slotman, M.D., medical director of the bariatric surgery program at Our Lady of Lourdes Medical Center.
"One of the requirements is that the patient must have failed multiple medically supervised diets. We have to acquire copies of the medical charts to send to the insurance company," he said.
"Insurance companies usually require six months of primary care office notes that discuss the (failed) diet and some are starting to require some formal pre-surgical diet education process as well."
The patient must do some of this initial work regarding his or her insurance coverage to establish whether or not the health policy covers bariatric surgery.
Health insurance companies require that the patient have a body mass index greater than 35 to 40, with severe co-morbidities (health conditions) such as diabetes, hypertension and sleep apnea, said the surgeon. (The BMI is a popular index, using height and weight calculations, to estimate health risk related to weight. The upper limit normal BMI is 25. See a BMI calculator here.
Please consult your own carrier to determine if your benefits cover weight-loss surgery. Our Lady of Lourdes Medical Center accepts nearly all commercial health care plans, as well as Medicare and Medicaid.
To locate a Lourdes Health System bariatric surgeon by phone, call 1-888-LOURDES.
