Insurance coverage for metabolic and bariatric surgery is very complicated.
The first step in understanding your insurance coverage for metabolic and bariatric surgery is by contacting your insurance provider and determining if metabolic and bariatric (weight loss surgery) is covered. Please review the insurance coverage worksheet to determine exactly what questions you should ask. If you have further questions about your coverage please contact our bariatric coordinator by calling 715-221-7422
How do I find out if metabolic and bariatric surgery is covered by my insurance?
There are specific questions you should ask your insurance provider to better understand how metabolic and bariatric surgery is covered by your insurance. This handout has detailed questions you should ask your health insurance provider to determine if metabolic and bariatric surgery is covered.
What if metabolic and bariatric surgery is not covered by my insurance?
While your insurance company may say metabolic and bariatric surgery is not covered under your insurance plan, there may be additional options that we can walk you through. This may include:
- Appealing their decision by organizing your medical records, co-morbidities and history of dieting efforts to establish that weight loss surgery is medically necessary.
- Choosing a different insurance plan during your next cycle that covers bariatric surgery.
- Using our self-pay or pre-payment program to pay for the surgery. Keep in mind that the surgery may not be covered by insurance, but many of the other required visits with nutrition, behavioral health and other specialists may be covered.
Obtaining final insurance authorization
After you have met all the requirements for surgery, we will work with your insurance company to obtain insurance authorization. Most insurance companies have 30 business days to reply to the authorization.
If you are approved for the surgery, we will then call you to schedule your surgery day. If the request was denied, we will review the reasons and work with you to appeal the decision with the insurance company.