You and your doctor have determined bariatric surgery is the right choice for you, and you have insurance coverage for surgery under your present plan. Now that you’re ready to go, it’s crucial that you plan ahead so you don’t accidentally lose that coverage.
If you are planning to have bariatric surgery, you need to be very aware of any changes to your insurance coverage that might be on the horizon, whether that means your employer changing to a new insurance company, a new plan with the same insurance company, or even changes to coverage in the same plan.
Insurance coverage changes can take place on January 1, but many change at other, less expected times, like June or July. You and your surgeon’s office need to plan ahead to make sure you’re not in the position of thinking you have coverage, only to find out you’ve lost it when your employer changed or renewed its insurance plan.
In addition to planning the surgery for a period when you have coverage, you also need to think about any supervised weight loss programs you may be required to complete before obtaining approval for bariatric surgery. If you are trying to schedule surgery before your coverage ends, you’ll need to allow enough time to complete that program before the surgery.
Remember that if your insurance is going to change, it is the insurance you have on the day of surgery that counts, not the insurance you have when you start the process of getting approved or when you begin your supervised diet.
What To Do If Your Insurance Plan is Changing
If you are planning to have bariatric surgery and you have coverage under your current insurance plan but you know your insurance plan is going to change, here’s what you need to do:
- Have your surgeon submit a preauthorization to the insurance plan as soon as possible. Even if your initial request is denied, an early submission gives you time to get though the appeal and independent review process while you still have your current plan, which increases your chances of getting approved.
- Carefully review the coverage and exclusions of the new insurance plan. Ask your employer or insurance company how to get a copy of the coverage booklet, either in paper form or online. Once you have that booklet (which is not the same as the provider directory or the summary sheet showing deductibles, co-pays, and comparisons with your old plan), review the details of what is and is not covered, paying special attention to requirements or limitations for “weight loss surgery,” “obesity treatment” or similar terms. Also check the section on appeals, including your rights to challenge denials if they occur.
- Let your bariatric surgeon know if there will be any changes to your coverage for weight loss surgery, and plan the procedure accordingly. If you need assistance in learning about your coverage and rights, contact us.
Contact PRIA Appeals to Schedule a Free Assessment
If you have been denied insurance coverage for a necessary medical treatment or procedure, PRIA Appeals can help!