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How Do I Find An Insurance Plan That Covers Bariatric Surgery?

Surgery to help lose weight

How Do I Find An Insurance Plan That Covers Bariatric Surgery?

Postby Lonell » Fri Sep 26, 2014 5:44 am

In January I will no longer be on my parents' plan, as I will be too old.
I am finding it impossible to search for a plan and know what procedures it covers. What do I do?





In February I will be eligable for health insurance through my job, but is there a way I can find out the difference between individual healthplans and know if it covers bariatric surgery?
Lonell
 
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How Do I Find An Insurance Plan That Covers Bariatric Surgery?

Postby Marlayne » Fri Sep 26, 2014 1:08 pm

Bariatric surgery is a hot topic in the industy and the likelyhood of it being covered on an indivudual plan would be extremely rare. This surgery is up there with Viagra as most popular contract exclusions in healthcare.


Your rate of success will increase significantly in the HMO arena and possibility on a larger employer group medical plan. Request a plan design from your employers HR department, it should indicate if it is covered.


Frankly, I would dismiss the idea of finding Indivudual coverage that would cover this as you would be rated up significantly even if was a cover benefit. You should really explore the group medical as the underwriting requirements are nominal.


Keep in mind, even if the surgery is covered the insurers require you to jump through massive hurdles. Be sure you have all your authorizations in place prior to taking the jump.
Marlayne
 
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How Do I Find An Insurance Plan That Covers Bariatric Surgery?

Postby Marlin » Fri Sep 26, 2014 1:44 pm

I don't know where you are located, but most of the legitimate bariatric centers have insurance possibilities to help you.
Contact them or check their websites to see what they are offering.
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How Do I Find An Insurance Plan That Covers Bariatric Surgery?

Postby Baudoin » Fri Sep 26, 2014 8:51 pm

Like dimples said, you're not going to be able to get it on a private policy - if you NEED bariatric surgery, no private policy is going to write you, due to your BMI.


You're ONLY bets are 1.
wait for the health insurance with your employer 2.
save your money to do it on your own or 3.
knock your socks off to try to do it on your own without the surgery.
Baudoin
 
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How Do I Find An Insurance Plan That Covers Bariatric Surgery?

Postby breanainn » Sat Sep 27, 2014 10:08 pm

Your best bet is to get coverage through an employer group.

Bariatric surgery is almost always going to be excluded from an individual, privately purchased plan.
And, as others have said, you may not qualify for an individually purchased health plan if your BMI and co-morbidities are significant enough to need bariatric surgery.
(Co-morbidities = conditions you have as a result of your weight issues - diabetes, high blood pressure, etc. )

Once you're eligible for your employer's plan, then you can inquire whether or not bariatric surgery is covered.
(If your employer offers more than one plan option, you should be able to request the details of each policy for use when deciding between the plans.)

Whether or not bariatric surgery is covered isn't a blanket decision by the insurance company for all groups.
It depends upon whether your employer group chose to include it in their coverage - many employers exclude it as an attempt to save on premiums.
XYZ Insurance Company might cover bariatric surgery for Employer #1 (who chose to include it), but exclude bariatric surgery for Employer #2 (who chose to have it excluded to cut their premiums).
You can't just use the name XYZ insurance company to determine whether they cover bariatric surgery - you have to know what specific policy you'll be enrolling under.
Coverages can vary widely, even within the same insurance company.


BTW - you should be advised that there is a lot of documentation required to get insurance approval for bariatric surgery.
If you're certain that you'll start pursuing that option come February, you should start gathering some of the documentation now to speed up the approval process for you.

Some of the standard items you'll typically see requested from the insurer: 5 year documented weight history, documented non-surgical weight loss attempts, absence of active substance abuse for at least 12 months prior, etc.
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