HOW TO PROCEED When You’re Denied (Bariatric) Weight-loss Surgery
To view a PDF version of this article, click here. Please, be aware: The conditions “bariatric” and “weight-loss” are used interchangeably throughout this post. Kick, scream, yell, cry, curse, and take a breath. Kick, scream, yell, cry, curse, and take a few more deep breaths again. Of 1 thing you can be sure, you are not the first person to be denied approval for weight-loss surgery from your insurance; nor will you be the last. While access to treatment has most improved for most within the last couple of years certainly, coverage for weight-loss surgery is not standardized and can vary predicated on your company and your insurance coverage tremendously.
Frequently, we would be quick to blame the insurance company for lack of coverage. It is important to make a clarification. In order to provide coverage for his or her employees, companies must purchase a “rider” for weight-loss (bariatric) surgery coverage. Self-insured employers (typically bigger employers where the money paid for their claims originates from their own pocket) frequently provide weight-loss surgery benefits.
In this situation, where the ongoing company has elected to provide coverage, the insurance company now applies their standard requirements to those seeking surgery. If the employer has coverage and you meet the criteria on the plan, you are approved, right? “We didn’t receive the letter from your primary care doctor.” – Be confident, it was sent. “We don’t have documentation of failed prior weight-loss attempts.” – This too was sent.
“Documentation of weight for one of the previous five years is missing.” – Uh-huh, sure it is. Ask your surgeon’s office to set up a “peer-to-peer” review. That’s where your surgeon will consult with the medical director at the insurance provider to examine your documentation and to explain how you meet the criteria.
As an alternative, you may also ask the human resources director at the company to intervene on your behalf. In case your employer is self-insured, however they do not have a bariatric surgery benefit, please visit the OAC Web site. There, you can find a known fact sheet titled, “Why it seems sensible to provide treatment for obesity through bariatric surgery.” This fact sheet is designed for you to share with your employer, an insurance provider, elected officials, and others. It offers in-depth information on the advantages of weight-loss surgery.
All of this research you’ve done on bariatric surgery? Take it too. Ensure that your decision manufacturers are informed. You are unable to rely on someone else to teach them for you. Nearly all standard insurance plans sold to businesses do not have bariatric surgery benefits included. For smaller businesses that are not self-insured, they pay an arranged amount of money per worker to the insurance provider; the amount of money will go there and stays there it doesn’t matter how much is paid in promises.
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In most ways, these small companies haven’t any access to purchase an insurance plan that delivers bariatric surgery coverage. The long-term solution is to advocate for access to care. Advocacy can frequently be intimidating to a person who hasn’t advocated for a cause; however, the OAC has made advocating to your elected officials for coverage of weight-loss surgery extremely easy. Simply type in your zip code and you’ll instantly have access to all your elected officials’ contact information.
For tips about what things to write to your elected officials, please click here. While you are advocating for future coverage, it might not be to help you in your immediate goal to have surgery enough. You as well as your employer will both benefit from you being truly a healthier and more productive employee and there is no need to go through your insurance company. Additionally, there are healthcare financing companies designed for those choosing to self-pay for surgery, bypassing insurance completely. Consult with your human resources division – is your organization self-insured? Find out if you meet their criteria.