Insurance Challenges


Specifics of Insurance Coverage
The surgical treatment of morbid obesity is a covered benefit under many insurance policies, but benefits depend on the specifics of your coverage type and policy terms. While individual discrimination is illegal, each person is still unique within a policy, due to standard clauses such as those limiting coverage for pre-existing conditions. Because of the intricacies of instance policies, your particulars must be considered uniquely within that policy, even if several people hold a similar policy.

As well, policies within the same company can differ. These differences can be attributable to, length of employment, departmental differences possibly negotiated in collective agreements, employment status and/or supplemental policies or benefits that may be the financial responsibility of the employee him or herself.

Exclusions
Some insurance policies have exclusions written into them, and it is not uncommon for weight loss surgery to be such and exclusion. Unfortunately, such exclusion would make it impossible for insurance to cover the payment of the procedure even if it is deemed medically necessary.

Possible Strategies
If your coverage has an exclusion, you may seek to exchange policies if possible. This may be done during the time of your company’s open enrollment, the annual renewal date of a company’s insurance policy. There may be additional costs involved to you in order to accomplish this, again depending on the stipulations and insurance plan established by your employer. If you choose to do this, you must very carefully discuss each optional plan with your insurance representative or Human Resource personnel before agreeing to enter into any new policy.

You may need to change or modify a spouse’s policy, in which case, the same precautions as above would apply.

You may have to finance or privately pay for the surgery.

Health insurance is, of course, one of the most common benefits offered by employers; however, with the global economic downturn currently faced by many businesses, many employers may be decreasing the scope of the benefits they offer, or the breadth of medical conditions covered by a previous yeas’ policy. In any case, employers typically specify the type of coverage their employees receive. You may be able to influence your employer’s coverage decisions by:

  • Meeting with Human Resources Representative
  • Share your story as to how you believe bariatric surgery will benefit not only you, but your organization as well.
  • Bring the information about the many benefits of bariatric surgery such as increased energy levels and decreased health issues that can translate into increased saving for the employer in the long term
  • Talk about your weight issues openly and without shame. If others know about your struggle and you demystify your plight, you may encourage less bias against yourself and other employees who struggle with their weight and who also may benefit from various weight loss procedures.

We Will Get You Approved
If you have the benefits within your policy and you meet the medical and policy criteria, we will get you approved for surgery. Let us contact your insurance carrier and help you to take the first steps toward discovering your eligibility requirements for bariatric surgery. Discuss your personal and health goals with us, as well as your surgical options. If you are eligible and should choose to pursue weight loss surgery, we will be in your corner right from the beginning to help you recognize your insurance benefits and see you down the road to success.

Our office staff has the experience and the familiarity with managed care. Having this knowledge is integral to what we do and how we can help you. If there is a strategy we can identify to help you with your insurance coverage, we are happy to guide you.