Weight Loss Surgery & Insurance Denials
Sometimes, an insurance company will refuse to pay for weight loss surgery, even if the surgery has been recommended by your physician. This refusal is called an insurance denial.
Why Do Insurance Companies Deny Weight Loss Surgery?
Insurers may deny coverage for weight loss surgery for several reasons. They may claim it is not medically necessary, that it is not a mainstream medical treatment (i.e., that it is “experimental” or “investigational”), or that your insurance plan excludes weight loss surgery. Learn more about why insurers deny weight loss surgery.
It’s not just bariatric surgery. Insurance companies routinely deny coverage for a wide range of procedures and treatments because they know most patients won’t question their decision. According to one study, healthcare insurers deny almost one out of every five claims, and less than 1% of those denied claims are appealed.
Don’t let your insurance company prevent you from getting the care you need! In many cases, insurance denials can be successfully overturned.
What Should You Do When Your Insurance Company Denies Your Weight Loss Surgery?
If your insurance company has denied coverage for your weight loss surgery, don’t give up! You can challenge their decision by filing an insurance appeal, which is a request for a health insurance plan or payer to review and change a denial of coverage.
Here’s how it works:
- After you receive a denial from your insurance company, saying they will not cover or pay for the procedure, you contact PRIA Appeals.
- PRIA Appeals will conduct a free assessment of your denied case. We will collect information on your insurance company, policy, the procedure denied, your medical records and any other pertinent information.
- If we determine that an appeal is possible and you want to go ahead with the process, you don’t have to do anything else! PRIA Appeals will work on your behalf directly with the insurance company throughout the appeal process, which usually takes 30-90 days.
Contact PRIA Appeals to Schedule a Free Assessment
If you have been denied insurance coverage for bariatric surgery, PRIA Appeals can help! We can handle all aspects of the appeal and will fight to get you the care you need. Please call us directly at 877.992.7732 or use the form below to provide your contact information and tell us about your situation and we will get back to you shortly.