Gastric Bypass Surgery – Will Your Insurance Cover It?

(PRWEB) July 12, 2005

If you're wondering if gastric bypass surgery is covered by your policy, “you should read your benefit booklet and understand your rights before you call your health insurance carrier,” according to Jonni Good, a customer service specialist with a large health insurance company, and the owner of http://www.stress-free-weight-loss.com.

When people begin to consider gastric bypass surgery as a treatment of obesity, one of the most pressing questions is “will my insurance cover it?” The surgery itself can cost from $25,000.00 to $35,000.00. If there are complications, the costs can skyrocket to over $100,000.00.

Unfortunately, it is not easy for the average policy-owner to understand his or her benefits for gastric bypass surgery. Many health insurance policies specifically exclude gastric bypass surgery from benefits because of the high costs and common complications for this procedure. Even when the procedure is covered by their insurance, many people may not understand the pre-authorization requirements or the medical policies that are used to determine eligibility.

Ms. Good has just released a 12-page online report titled “Gastric Bypass Surgery and Health Insurance” to help her readers understand their benefits and rights. The report answers many of the questions that are asked by health insurance customers who are considering gastric bypass surgery, and explains many commonly misunderstood terms, such as “contract exclusion,” “pre-authorization,” and “medical necessity.”

This report also helps readers find a copy of their insurance company's official medical policy on bariatric surgery. “If the surgery itself is eligible for benefits, you will still have to meet the criteria found in the medical policy before your own surgery will be covered,” ccording to Ms. Good, so it's important to read the medical policy and discuss it with your doctor before you talk to your insurance company. Most insurance companies use the gastric bypass criteria from National Institutes of Health, which are available online at http://win.niddk.nih.gov/publications/gastric.htm but they may add other requirements, such as a trial period of medically supervised diet and exercise.

If your insurance company makes a mistake and turns down your request for surgery even though you meet all their criteria, you may need to file an appeal. Ms. Good's report helps you find out what you need to do in order to appeal your insurance company’s decision.

The full report can be found at http://www.stress-free-weight-loss.com/health-insurance.htm

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