Now that you are considering bariatric surgery, it is important to know if your insurance company will cover the procedure. While most insurance companies cover obesity surgery in full, some do not and others may have restrictions in coverage. All plans are different and the amount of coverage depends on the arrangement your employer has made with your insurance plan. It is crucial that you call your insurance provider to determine if bariatric surgery is covered. We have a specialized insurance coordinator who will work with you to obtain an insurance authorization.
Most insurance companies require documentation regarding your previous attempts at weight loss. Important documents may include:
- A two year weight history. Some insurance companies may require up to five years.
- Documentation from a medical provider of supervised diets and weight loss medications prescribed
- History of any commercial diets you may have tried (i.e. Weight Watcher, Jenny Craig, NutriSystem)
- Any exercise program records
Many times, insurance companies require official documentations – the information listed on our intake form is not sufficient. You may need to contact the physicians who have treated you for weight loss in the past for specific documentations.
Our insurance coordinator will assist you in the process of obtaining authorizations. We will work with you every step of the way and do everything necessary to obtain an authorization for your procedure. After submission, our office will contact you when your insurance company makes a decision. Each insurance carrier varies in the time it takes to make a decision regarding your surgery.
If your surgery is denied by your insurance company, our insurance coordinator will work with you to acquire an appeal or discuss self-pay options.
Call our office if you have any questions regarding your coverage or authorizations.
View a list of insurance companies that are accepted by the Metabolic and Bariatric Institute at Allegheny Health Network. The chart will help guide you in understanding specific requirements for insurance authorization.
This guide does not guarantee that you have bariatric coverage and is not an inclusive list of all insurance companies that are accepted. Please contact our insurance coordinator directly for any concerns.
Insurance coverage for endoluminal revisions varies by state and insurance providers. Some insurance companies still consider these procedures investigational and do not cover these procedures. Our office has an established process to help make this process as smooth and successful as possible. Our office will submit a request for an authorization. If the authorization is denied, your physician will do a peer to peer review. If all previous appeals are denied, you may proceed with a member appeal by calling your insurance company directly. Our office will work with you to put you in contact with a 3rd party contractor to assist you with your appeal. However, if all fails, there is a self-pay option.