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.