Does Insurance Cover Revision Weight Loss Surgery

September 08, 2021 Post a Comment

Luckily for Medicare patients revisions are covered if they find your case to be medically necessary. Many insurance providers are now also of the opinion that covering weight loss and revision surgery now will.

I Need A Revision To My Bariatric Surgery Will My Insurance Cover It Obesity Action Coalition

The short answer is yes.

Does insurance cover revision weight loss surgery. Unfortunately it is very common for the American health insurance companies to deny paying for bariatric surgery. Bariatric Surgery Weight Loss. 1 2 3.

Blue Cross Blue Shield Federal Employees Program and Blue Cross Blue Shield Florida covers weight loss surgery. While this may sound sneaky it is an ethical practice. The medical weight-loss referral that changed Linda Shaws life.

Whether the weight loss surgery covered by insurance or not it varies on your insurance company and your unique situation. As for everyone else if your insurance does cover revision weight loss surgery you want to be aware of all the required documentation required before submitting the claim. However if you are seeking a revisional bariatric surgery because of less-than-optimal weight loss or weight.

To answer your question does insurance cover weight loss surgery it depends on case to case. Read on for the long answer If your insurance does not cover weight loss surgery this is called an exclusion This means that the employer who provides the insurance chose to exclude surgical weight loss from coverage in order to purchase a cheaper plan. Medicare Coverage for Gastric Bypass Revision Certain recipients who satisfy Medicares requirements for coverage of bariatric surgeries like the Roux-en-Y gastric bypass may also be covered for a revision with their Medicare benefits.

In general the coverage by insurance providers for revisional bariatric surgery mirrors that of the primary procedure eg if youre 100 pounds over your ideal weight or you have significant obesity-related health problems. Patients plan covers the original procedure and the revision. And second that this is a request to correct a failed procedure that may cause significant problems in the near future and as such it is not for obesity or weight-loss.

Patient followed the post-operative nutrition and exercise plan. Bariatric Surgery Weight Loss. However if your doctor submits the above claims using a NON-weight loss surgery CPT code the claims will likely be considered covered.

If your surgeon or primary care physician submits the above claims using a weight loss surgery CPT code your insurance is unlikely to cover it. The criteria for coverage include. If your doctor submits one of these claims using a weight loss surgery CPT code Current Procedural Terminology Code your insurance is unlikely to cover it.

To help with the insurance approval process send all documentation of previous weight loss attempts. Coverage for revisional bariatric surgery is determined by your specific insurance provider and plan. A repeat or revision of a bariatric surgery performed on a patient is covered if considered medically necessary.

Below we look at what these are so you know what to expect. As is often the case with Medicare certain conditions have to be met for Medicare to pay for your gastric sleeve revision. If your BMI is greater than 40 or if you have a BMI of 35 along with a medical problem related to obesity.

Generally if you are experiencing complications related to your original procedure youll be approved because of a medical need. If bariatric surgery is requested or prescribed under the Early Periodic Screening Development and Testing EPSDT program it is evaluated as a covered service under EPSDTs standard of coverageservice to be. But if your doctor uses a general CPT code it probably will be covered.

ObesityCoverage strongly feels that morbid obesity is a disease and every insurance company should cover these life saving procedures. Insurers increasingly recognize that obesity is a progressive disease and surgery or a revision procedure can provide a viable medical solution. But not 100 of the time.

Medically necessary safe and effective and non experimental. Many insurance companies require another diet history. What types of revision surgery are reimbursed by insurance.

Medicare will cover the cost of gastric sleeve revision. My current insurance will not cover the revision because I was self pay 12 years ago. Many insurance companies will provide coverage for weight loss surgery if it is considered a medical necessity and the patient meets the National Institute of Health NIH requirements for bariatric surgery.

First that weight-loss surgery should be a covered expense because it is used to treat co-morbidities in addition to obesity such as diabetes or hypertension. They even said that if I was eligible for the revision I would still have to follow the 7 month protocol for the WLS. Medicaid may cover your weight lossbariatric surgery -- if you meet the qualifications according to Brian Martucci Money Crashers Minneapolis-based finance editor.

Insurers all have different requirements but they generally cover revisions to the band sleeve or bypass to address weight regain if you meet these criteria. The short answer is no. So we are happy to report that BCBS Florida and BCBS Federal covers weight loss surgery.

I didnt have their insurance at that time but they said that doesnt matter.

Weight Loss Surgery Brochure Columbia Bariatric Associates