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Weight Loss Surgery Insurance Secrets: July Coverage Changes

Is Your Weight Loss Surgery Insurance Coverage Changing on July 1?

Not every insurance plan covers weight loss surgery. Many people are unaware that some insurance plans change on July 1, and in some cases your plan might change from one that covers weight loss surgery to one that does not.

If you are a bariatric surgery patient, you may have been told that once the office has confirmed that your plan covers weight loss surgery, you have nothing more to worry about. Unfortunately, that’s not true.

Verification of Benefits (VOB)

Usually, a bariatric surgery program will perform a “verification of benefits” (VOB) to confirm you have coverage under an insurance plan. It’s important to remember that after the VOB, bariatric patients must meet several pre-operative requirements, such as supervised weight loss efforts, various tests, and clearances from behavioral health and other specialists.

All this can take time—up to six months or more—and when it comes to insurance, time can be your enemy, especially when plans change. For example, confirming coverage in April won’t matter if your surgery is scheduled for August and the plan changed effective July 1 to eliminate bariatric benefits. When your August surgery date arrives, you could discover that the previously confirmed coverage for your sleeve gastrectomy, gastric bypass or bariatric revision is no longer part of your plan.

What Steps Should You Take?

To make sure you will have coverage when you need it, check to see if your benefits are based on a calendar year (January through December), or a fiscal year (July through June). Make sure you know your coverage on the day of your procedure—that is the important date! Taking a few minutes to check that now will give you peace of mind and allow you to plan better and ensure you get the coverage you deserve for the surgery you need.

If you have been denied insurance coverage for weight loss surgery, PRIA Appeals can help! Please call us directly at 877.992.7732 or fill out our contact form to tell us about your situation, and we will get back to you shortly.