As you begin the process to having weight loss surgery, there are many steps you’ll need to walk through. First, you’ll need to understand the benefits covered by your health insurance provider. Next, you’ll need to receive pre-approval for your surgery. Finally, you’ll need to follow through on all of the ordered laboratory tests, consultations, and studies that your bariatric team requires prior to your surgery date.

Speaking With Your Insurance Company

First things first- you need to understand what your insurance carrier provides coverage on for bariatric surgery.

The Obesity Action Coalition (OAC) has a lot of helpful questions to ask your insurance provider as you explore this information, such as:

• What are your health insurance benefits?
• What is the definition of morbid obesity according to your plan?
• If any, what coverage of morbid obesity is listed?
• What limits and/or requirements are stated in order to receive morbid obesity treatment?
• Is there a maximum dollar limit on your benefits?
  What treatment options are excluded or specifically included?
• What is the co-payment for medical services?
• What testing is covered, such as nutritionist, psychologist, labs, sleep apnea study, ultrasounds, etc.?
• Does your insurer require weight-loss prior to surgery? If so, what percentage or number of pounds is required?

Every insurance plan is different, so it is very important that you learn the details specific to your insurance policy.

The Pre-Approval Process:

After speaking with your insurance provider and having a better understanding of your bariatric surgery coverage, the next step is receiving prior authorization for your procedure (almost always required for weight loss surgery). 

Most of the time your bariatric surgical practice will do this on your behalf, but if not- you’ll need to do this on your own.

Documentation of important medical “codes” are necessary in order to process your insurance claim and allow for successful reimbursement.

If you are denied, you can file an appeal or look into other options of financial support when paying for your surgery.

Next Steps

Once you begin meeting with your surgical team, you will have lots of consultations with other medical / bariatric providers, lab tests, studies, and nutritional counseling appointments. It is important to complete all of these requirements in order to proceed with surgery in a timely and safe manner.

For more specific details on the initial steps in pursuing weight loss surgery, be sure to check out the Obesity Action Coalition’s “Helpful Tips” webpage.