If you’re looking into gastric bypass, insurance providers may or may not cover the operation. The sad fact is that many insurance policies have an “exclusion” on gastric bypass surgery. What this means is that, even though the surgery may be deemed medically necessary, the policy simply will not cover the operation.
Fortunately, there are several groups working to combat this injustice and pass laws and regulations that would have all insurance policies covering medically necessary gastric bypass surgery, but the day when we will see complete coverage for bariatric patients is still in the future. Until then, all we can do is look into our insurance policies and see if we’re covered. Luckily, you do have options.
There is of course the chance that your new policy might not cover obesity surgery, either. Look into a policy before signing up to make sure you’ll be covered for medically necessary gastric bypass surgery.
Switching to a spouse’s policy
Many insurance providers offer shared coverage for married couples, so you may be able to switch to a spouse’s policy, assuming that their policy does, in fact, cover obesity surgery.
If you cannot afford to finance the surgery on your own dime, it may be possible to take out a loan or find a sponsor. Assuming your insurance policy might be willing to cover gastric bypass surgery, they may require you to first provide some information.
This would include a detailed history of your diet in the past (as well as you can document this) as well as a report on what you’ve been eating lately, your current eating and snacking habits, etcetera.
This would include your current height and weight, as well as your body mass index, or BMI.
A psychological evaluation
Some insurance companies will insist upon a psychological analysis to judge your emotional and mental stability before going through with
gastric bypass surgery (which, to be honest, can be emotionally trying).
As thorough as possible, most insurance companies will require a well documented medical history before approving a gastric bypass operation.
All of the above will be in addition to a variety of medical tests and evaluations. To know exactly which tests you will need to have conducted, talk with your insurance company and inform your doctor. Perhaps one of the main reasons gastric bypass insurance can be somewhat hard to come by is that the operation has an unfortunate stigma as being unnecessary, as if it were a quick fix for lazy people. Of course, this isn’t the case. Gastric bypass surgery is a last resort for people suffering from severe, even life threatening problems with obesity. It is not something people normally go through for vanity or to improve their body image, rather, it is for one’s long term health and to prolong one’s life.
Many insurance companies, unfortunately, do not see it that way. If you are battling severe obesity and feel that you need gastric bypass surgery in order to live life to its fullest, you should look for an insurance company that understands your needs, one that is geared towards people struggling with obesity. The right insurance company can be the greatest ally for a person suffering from morbid obesity, but the wrong insurance company can be the greatest stumbling block. Know your policy, talk with your insurance company and your doctor, and try to subscribe to an insurance policy that is right for you, one that will cover your needs.
Luckily, even if you are initially denied approval for a gastric bypass operation, you still have the option of appealing the denial. In some cases, this can result in your denial being overturned. If your carrier persists in denying your coverage, you may seek legal assistance. If at all possible, try to find coverage, by any means necessary.