Many insurance companies provide coverage for bariatric surgery. Obtaining approval for surgery can often be a very time consuming and tedious process. The need for surgery and the decision of coverage by insurance usually depends upon determination that surgery is medically necessary to reduce health risks and improve the quality of life for the patient.
In determining if the procedure is medically necessary most insurance companies require past medical records pertaining to obesity disease, medically related conditions (diabetes, high blood pressure, sleep apnea, etc.) and diet and exercise programs when requesting approval for weight-loss surgery in order to prove “medical necessity.” Many insurance plans now require a physician managed diet and exercise program. This usually consists of well documented monthly visits to your doctor varying from 6-12 months. Be sure to ask what your insurance requires.
We recommend that you obtain copies of your medical records from your primary care physician and any other healthcare professionals who have treated your obesity and comorbidities before your first visit. We strongly encourage you to begin this process early to expedite your approval process. Most hospitals and doctor’s offices will require you to sign a release form to have your medical records sent to us. We can provide you with a form if needed.
Your insurance company may also require cardiology, pulmonary and endocrinology evaluations. We will do our best to assist you in this preliminary process, however due to the high volume of requests for weight-loss surgery; the Illinois Bariatric Center cannot research your particular insurance plan. It is your responsibility to determine what is required for your plan. You will be responsible for any costs not covered.
We will make every attempt to assist you in dealing with your insurance carrier. However, we ask that you assist us and cooperate with us fully to facilitate the process. It is often lengthy and burdensome and your assistance and patience is essential if we are to be successful.