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Gastric Bypass
Surgery
Appeals and
Denials
Will my insurance pay for my
surgery?
Once your surgeon has
determined that surgery is
medically necessary, we must
seek approval in writing
from your insurance company.
More than likely, we will
know in advance what your
insurance company will
require but there are
occasions where the
insurance company will send
us a list of requirements
which are customized to your
policy. You may be
able to check on-line, the
policy bulletin for your
particular company.
Please keep in mind that
not all insurance companies
require a lot of
documentation and that we
will help you through the
process.
What if my insurance
company denies my request?
If your insurance company
denied coverage for surgery,
don't give up hope. In many
cases, providing additional
information in the form of
an appeal letter could
result in your denial being
overturned. If your
insurance carrier continues
to deny coverage, you may
consider seeking legal
assistance. We have an
appeals expert on our staff.
Appealing a
Denial
If the insurance
company turns down
your request for
gastric bypass
surgery, you may be
able to appeal the
decision. Many
people do not take
advantage of the
appeals process or
know of the laws
that govern
insurance companies
in their state. Your
health is worth the
time and energy it
takes to advocate
coverage.
It's critical that
you understand your
health insurance
policy thoroughly,
including the number
of appeals you are
allowed and what,
exactly, constitutes
an appeal. The
number of denials
varies among
policies and is
detailed in your
Certificate of
Coverage.
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