Weight Loss Surgery Payment Frequently Asked Questions
Q. What Are My Payment Options?
For many people, weight loss surgery is affordable because it is covered by their health insurance plan. People who do not have insurance coverage for lap band and other surgeries must pay for it on their own.
This is called self-pay or cash-pay. Some patients pay for their own surgery and consider it a critical investment in their 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.
Q. How Do I Work with My 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 weight loss program. NewStart has weight loss coordinators 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.
Quick Fact: Writing a Weight Loss History
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 weight loss surgery program and health insurance company.
Q. How Do I Appeal a Denial?
If the insurance company turns down your request for lap band or other weight loss 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 Weight Loss Surgery Program
Assistance is key. It is critical that you work with your bariatric program to determine the correct approach to appealing a denial. We are there to assist you and to help you adhere to your policy's requirements.
Possible Options After Appeals
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.
Ready to Get Started?
Our NewStart program is designed to ensure that when the day of your surgery arrives, you'll be ready and in the best possible condition for a fast, healthy recovery. Choose a location to start finding out if weight loss surgery is right for you.