Financial and Insurance Information when Considering Gastric Bypass Surgery

?Bariatric surgery usually requires three or four days of hospitalization, followed by a recovery period lasting from one to six weeks. This depends on the surgical procedure, the patient’s physical condition, and the kind of work he or she does.

A number of insurance policies cover this type of surgery, and the total cost varies with the patient’s insurance coverage, and any contractual agreement made with the hospital where the operation is performed.

In general, insurance coverage is available when it is determined that bariatric surgery is needed to improve the patient’s health, treat a life-threatening condition, and provide for a normal lifestyle. The patient must also be proactive in proving the need for this treatment and gathering physician opinions and corroborating data to prove that medical necessity exists.

These are the types of policies available for covering gastric bypass surgery:

? With an indemnity insurance policy, you will owe a 20% copay, and they often cover surgery that is medically necessary to treat clinically severe obesity.

? Preferred provider organizations (PPOs) may cover this surgery if it is medically necessary. and you must choose a physician within the network, which makes it less expensive. However, there is some risk that they will contract with a surgeon who has minimal experience in gastric bypass surgery.

? Frequently, HMOs and other managed care insurer want to avoid covering this type of surgery. They do not state this explicitly in their contract, and they must provide treatment if it can be demonstrated that surgery is needed to preserve the life or health of the patient.

? Medicare uses certain criteria to cover weight reduction surgery. The most essential requirement is that the patient must be totally disabled in regard to work or the regular activities of daily life.