By Carlos Diez

Most of us would like to loose a few pounds for many reasons and why not it is considered being and living healthier. However, there are those of us who absolutely somehow must procure weight lost in order to functionally survive and retain our health or at least prevent comprising it further. One would think if obesity is a critical precipitator in the development of medical conditions than insurance companies should routinely offer preventative coverage with respect to weight related matters. But carriers do not usually concern themselves with that reasoning because they follow the informal logic that in a competitive marketplace, a few years from now you will probably have a policy with a competitor of theirs. With competition in mind and the cost of popular weight loss procedures such as Gastric Bypass or Lap Band Surgery ranging in the neighborhood between ten to thirty thousand dollars who can really blame them. With that said, we can come down to the conclusion that health insurance companies usually and normally do not cover these expensive procedures, or do they?

Some insurance companies actually cover this.

In general Bariatric Surgery comprises the preoperative laboratory or diagnostic expenses, cost for anesthesia, hospital confinement, and surgical fee. The procedural standard for surgically correcting obesity may come in many assorted variations Including Gastroplasty, Bilio Pancreatic Diversion, Duodenal Switch Distal Bypass, Gastric Bypass, and Larascopic Adjustable Silicone Gastric Branding, more commonly described as Lap Band for short. The Lap Band system is a device designed to produce a small upper gastric pouch with a narrow opening from it into the lower stomach. It causes a sense of fullness after only a few bites of consumed food intake, and it helps make the decision to reduce overall consumption therefore losing weight. The Gastric Bypass operation encompasses redirection of the esophagus past the gastrointestinal tract to physically limit consuming any relative excess of food in one sitting.

If you shop around and speak to several licensed health agents you will notice that most will reject the idea because many policies have exclusions inherent in their provisions regarding it as elective. This basically means that even though treatment may be medically necessary it will not be a covered benefit; however some insurers will cover it if certain requirements are met. The trick is finding the carriers and an agent that can assist you.

Let’s review how some insurers determine eligibility for coverage.

One of the most crucial determinants for consideration from Blue Cross Blue Shield will be documented clinician notes showing presence of morbid obesity for duration of five years. Cigna will deny request if documentation along with a consultation from a dietician and psychological evaluation is not submitted. Aetna is probably the strictest requiring medical clearance for a proposed insured having a history of psychiatric disturbance or who are under the care of a psychologist and prescribed certain psychotropic medications while being obese. Medicare will provide coverage if you suffer from obesity related illness such as diabetes or coronary heart disease in addition while being overweight. Last but not least there is always the possibility that they can deny your application altogether because of respective height and weight guidelines, however thanks to legislation that may change soon.

We can help.

At our health insurance agency we will prepare a certified letter to establish the criteria for medical necessity of weight loss surgery and obtain a pre-authorization from your insurance company after we locate a carrier who provides this coverage within your geographic region. We will need some facts and records from you for preparation of this letter such as height, weight, body mass index, and documentation proving how long you have been overweight. Insurance companies will not accept morbid obesity as enough criteria for medical necessity. They will require extensive literature documenting obesity related conditions and impairments including the effects it has had on your everyday life. That wraps it up folks.

About the Author: Carlos Diez is a senior benefits consultant for Health Insurance Buyer a referral service that refers consumers to the insurance carriers that can best fit their wants and needs. He holds life, health, and annuity licenses in 48 states and is appointed with over 88 carriers. Get a no obligation free consultation so we can help you obtain the weight loss you want and need..

Source: isnare.com

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