Does insurance cover duodenal switch surgery?
The good news is “Yes!” — most insurance companies will cover this type of weight loss surgery! However, it is important to remember that everyone’s insurance is different, and that what is covered by one person’s policy may not be covered by another — even if the policies come from the same insurance company!
Duodenal switch surgery, like other weight loss surgery, is not cosmetic — it is a surgical intervention for a problem which cannot be effectively treated by any other means. For this reason, most insurance companies will cover this type of surgery, assuming that you meet the nationally accepted criteria. It is important, however, to make sure that your plan does not specifically exclude weight loss surgery.
When you call to make an appointment, the insurance specialist at your surgeon’s office will ask for your insurance information — you can usually find this on your insurance card. After your consultation, the surgeon will compose a “Letter of Necessity” to your insurance company, stating all the reasons why your operation is medically necessary. When all your preoperative testing is done, the letter will be submitted to your insurance company along with all the preoperative information. This process is called “preauthorization” and is required for all elective surgery procedures. Every insurance company takes a different amount of time to preauthorize surgery -- some a few days, others a few weeks, and some a few months. Once you have your insurance approval, you are clear to move forward with surgery.
Medicare covers the Duodenal Switch
Medicare specifically recognizes and provides coverage for Duodenal Switch weight loss surgery, and hopefully this recognition by a Federal health plan will encourage more insurance payers to expand their coverage to include Duodenal Switch.
If your insurance denies, you have several options
The first step would be to appeal the denial. If this is unsuccessful, you may request an outside reviewer to examine your request. Finally, there are some legal firms that specialize in helping overweight individuals get approval for surgery. As a last resort, some patients have switched their insurance to a different company. Luckily, these more drastic measures are rarely needed.
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