Medicare News
Medicare is now providing coverage for the cost of
weight-loss surgery.
Medicare requires that the surgery be performed at a
hospital and by surgeons that are deemed a Bariatric Center
of Excellence. This means the hospital and the surgeons meet
strict guidelines as established by the American Society for
Bariatric Surgeons.
Lexington Medical Center and the surgeons of South
Carolina Obesity Surgery Center meet these guidelines.
If you would like more information about Medicare
coverage for weight-loss surgery, you may visit any of the
following websites:
Insurance Information
How long does it take to get insurance approval?
After your consultation is completed, it usually takes your
doctor 1-2 days to send a letter to your insurance carrier
to start the approval process. The time it takes to get an
answer can vary from about 3-4 weeks or longer if you are
not persistent in your follow-up. SC Obesity surgery center
has insurance analysts who will follow up regularly on
approval requests. It may be helpful for you to call the
claims service of your insurance company about a week after
your letter is submitted and ask about the status of your
request.
Can Insurance companies deny payment for a
life-threatening disease?
Payment may be denied because there may be a specific
exclusion in your policy for obesity surgery or "treatment
of obesity." Such an exclusion can often be appealed when
the surgical treatment is recommended by your surgeon or
referring physician as the best therapy to relieve
life-threatening obesity-related health conditions, which
usually are covered.
Insurance payment may also be denied for lack of "medical
necessity." A therapy is deemed to be medically necessary
when it is needed to treat a serious or life-threatening
condition. In the case of morbid obesity, alternative
treatments - such as dieting, exercise, behavior
modification, and some medications - are considered to be
available. Medical necessity denials usually hinge on the
insurance company's request for some form of documentation,
such as 1 to 5 years of physician-supervised dieting or a
psychiatric evaluation, illustrating that you have tried
unsuccessfully to lose weight by other methods.
What can help speed up the insurance approval process?
Gather all the information (diet records, medical records,
medical tests) your insurance company may require. This
reduces the likelihood of a denial for failure to provide
"necessary" information. Letters from your personal
physician and consultants attesting to the "medical
necessity" of treatment are particularly valuable. When
several physicians report the same findings, it may confirm
a medical necessity for surgery.
When the letter is submitted, call your carrier regularly
to ask about the status of your request. Your employer or
human relations/personnel office may also be able to help
you work through unreasonable delays. |
