Insurance Issues
Why does it take so long to get insurance approval?
If you have not heard anything from your insurance company by three (3) weeks after your intake appointment, it may be helpful to call their Member Services department and ask for "pre-determination" to check the status of coverage for the requested surgery.
How can they deny insurance payment for a life-threatening disease?
There may be a specific exclusion in your policy for obesity surgery or "treatment of obesity."
Insurance payment also may be denied for lack of "medical necessity." A therapy is deemed to be medically necessary when it is needed to treat a serious or life-threatening condition. In the case of morbid obesity, alternative treatments such as dieting, exercise, behavior modification, and some medications are considered to be viable alternatives to surgery. Medical necessity denials usually hinge on the insurance company's request for some form of documentation, such as one (1) to five (5) years of physician-supervised dieting or a psychiatric evaluation, to illustrate that you have tried unsuccessfully to lose weight by other methods.
What can I do to facilitate the insurance approval process?
Gather all the information (diet records, medical records, medical tests) your insurance company may require. Letters from your personal physician and consultants attesting to the medical necessity of treatment are particularly valuable. When several physicians report the same findings, it may confirm a medical necessity for surgery.
When the letter is submitted, call your carrier regularly to ask about the status of your request. Your employer’s human resources or personnel office may be able to help you work through unreasonable delays.