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Insurance Issues

Why does it take so long to get insurance approval? 
After your surgical consultation is completed, iyou will then need to complete the program through the Bariatric Clinic prior to requesting authorization from your insurance. It may be helpful for you to review your covered benefits on your plan. We provide a patient advocate to walk you through this process.

How can they deny insurance payment? 
Payment may be denied because there may be a specific exclusion in your policy for obesity surgery or "treatment of obesity." Insurance payment also may be denied for lack of "medical necessity." A therapy is deemed to be medically necessary when it is needed to treat a serious or life-threatening condition. In the case of morbid obesity, alternative treatments — such as dieting, exercise, behavior modification, and some medications — are considered to be available. Medical necessity denials usually hinge on the insurance company's request for some form of documentation, such as one to five years of physician-supervised dieting or a psychiatric evaluation, illustrating that you have tried unsuccessfully to lose weight by other methods.  
 
What can I do to help the process? 
Gather all the information (diet records, medical records, medical tests) your insurance company may require. This reduces the likelihood of a denial for failure to provide "necessary" information. Letters from your personal physician and consultants attesting to the "medical necessity" of treatment are particularly valuable. When several physicians report the same findings, it may confirm a medical necessity for surgery. Your employer or human relations/personnel office also may be able to help you work through unreasonable delays. As mentioned above, we have a patient advocate to assist you with this process.



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