If you are thinking about bariatric surgery and have doubts about whether it is right for you, you’re not alone. It’s a life-changing decision, and serious contemplation—particularly overcoming concerns and learning how to effectively cope with them—is part of the decision-making process for everyone.
For many people, bariatric surgery is affordable because it is covered by their health insurance plan. People who do not have insurance coverage for bariatric surgery must pay for it on their own. This is called self-pay or cash-pay. Cynthia, a gastric bypass patient featured in Real Patients’ Stories, paid for her own surgery and considered it a critical investment in her health.
Whether you have health insurance or opt for self-pay, you will need to prepare detailed written documentation. From diet history to co-morbid conditions, this information will come in handy.
How to Work with Insurance
Many people find dealing with health insurance companies to be intimidating and are not sure how to even get started. If your bariatric surgeon recommends surgery, consider the following:
- Your best resource for how to deal with your health insurance company may be your bariatric program. Many bariatric programs have patient advocates who work on your behalf with your health insurance company.
- Read your Certificate of Coverage (COC). A COC describes your insurance policy in detail, including what it covers and what it excludes.
- Write down your weight loss history. Go as far back as you can and include diets and exercise programs. If possible, pull together receipts for gym memberships and weight loss programs.
For more assistance, find a bariatric surgeon and program using the Surgeon Locator.
If the insurance company turns down your request for bariatric surgery, you may be able to appeal the decision. Many people do not take advantage of the appeals process or know of the laws that govern insurance companies in their state.
Work with Your Bariatric Program
Assistance is key. It is critical that you work with your bariatric program to determine the correct approach to appealing a denial. Your program is there to assist you and to help you adhere to your policy’s requirements.
Write a description of how morbid obesity decreases the quality of your life. Be sure to include details such as difficulty walking, socializing, or maintaining personal hygiene. This documentation can be useful for your bariatric program and health insurance company.
Even if you exhaust the appeals options, you still may have options:
- Independent review board: This is an option available to people in more than 40 states and doesn’t require a lawyer. Judgments usually are issued in 60 days. Check your state’s website for specific filing instructions.
- Arbitration: Some health insurance companies require patients to use a third party—other than the patient’s lawyer and the insurance company—instead of going to court.
- Litigation: This option is expensive and takes a lot of time.
Health insurance is one of the most common benefits offered by employers. Large employers often have self-funded health insurance and decide which health services and procedures are covered under their policy.
If this is the case, there are steps you can take if your employer has decided not to include bariatric surgery as a covered benefit.
Take time to meet with someone from Human Resources to find out why bariatric surgery is not covered. Share your story and how you believe bariatric surgery will benefit not only you, but your organization as well. It may be helpful to bring information about the many benefits of bariatric surgery—such as increased energy levels and decreased health issues—which can translate into savings for the employer.
Getting coverage approved by an employer can be a time-intensive process. Take the time to educate your coworkers about the surgery and its importance. By educating your coworkers, you’re not only fighting society’s obesity bias, but you also may find other people interested in bariatric surgery. For more assistance, find a bariatric surgeon and program using the Surgeon Locator.
Few people are able to pay cash up front for bariatric surgery. If you do not have health insurance and would like to have the surgery, you may want to explore alternative financing options.
Many bariatric programs work with financing companies to offer a variety of loans to patients. Your program coordinator can tell you more about the specifics of the options, such as the length of the loan and interest rate.
Another option that some patients have used is a home equity loan. A home equity loan uses the stake you own in your home as collateral. This option is one that should be pursued very cautiously, because you would be borrowing against your home.
- Depending on the financing company, large medical loans may require collateral such as your home. – Home equity loans may offer better interest rates.
- When it comes to self-pay, you should consider the expense of potential surgery-related complications because these may not be covered by your insurance either. It’s a good idea to hope for the best and plan for the worst.
The Surgeons’ Group, P.C.
Dr. John L. Mathews
D.M.D., M.D., F.A.C.S.
Diplomate, American Board of Surgery