Why Does Insurance Take So Long to Approve Bariatric Surgery?

February 20, 2020

The insurance process can vary between patients and insurance companies…even policies, but rarely is the process a short one. First, patients and providers are like have to deal with insurance companies that are pressed for time and may not be able to handle requests in a timely manner. Unfortunately, this is just a byproduct are the inefficiencies of the insurance market combined with the massive volume of preapprovals that need to be generated each and every day.

Further, the insurance company wants to be entirely sure that the procedure in question is medically necessary. Of course, this is not the case for emergency procedures which require immediate care. Other very straightforward procedure such as gallbladder removal or hernia repair also have fewer variables than bariatric surgery.

Most insurance companies also require a barrage of tests as well as potentially a three- or six-month medical weight loss program to be undertaken before surgery. This testing, along with the results of the medical weight loss, allows the insurance company to determine that bariatric surgery is indeed necessary, and the only option left.

Those who are a bit more skeptical may believe that the long waits and excessive requirements imposed by the insurance companies may be a way to discourage people from continuing the process and ultimately have them quit partway through.

So How Long Does Surgical Insurance Approval Take?

Most patients can be pre-approved for bariatric surgery within a matter of 90 days/12 weeks (with consecutive office visits throughout) if there are no medical weight loss program requirements, but there is no guarantee. However, one of the biggest holdups in the insurance process is getting the documentation and testing that the insurance company needs. Obviously, this requires quite a bit of back-and-forth between patient and practice and it is not uncommon for checklist items to fall through the cracks. We help you stay ahead by communicating regularly during the pre-operative process

What To Do in The Meantime?

The time waiting for the pre-approval does not have to be wasted. After your first consultation, you will learn more about what to do before surgery to make the whole process a lot easier. You can begin your diet and exercise regimen, stop smoking and start to lose a bit of weight to make surgery safer. By the time you receive the insurance company’s decision, you’ll have completed many of our prerequisites for surgery as well.

What Can You Do to Shorten the Wait?

While there’s no way to push the insurance company any harder to approve your surgery, there are ways to help them help you…consider the following:

Be organized…that’s about the best advice we can offer. Once you’ve attended one of our seminars, we will advise you to start the process with a call to your insurance carrier. You’ll understand exactly what you need to qualify for surgery. Further, our bariatric coordinator will assist you by performing a preliminary verification of insurance benefits.

Once you understand what documentation is expected of you, compiling it quickly, but thoroughly, is paramount. Remember, if your pre-approval is denied for any reason, even just an omission, it could take weeks to have it revisited and overturned. If you are ever in doubt about the requirements for surgery, we suggest that you contact both us and your insurance company to ensure that your application is complete and correct.

What if I’m Not Pre-approved?

There are cases in which patient will not be pre-approved for bariatric surgery or their policy specifically excludes bariatric surgery. This can be very disappointing, however there is always the option of self-pay – paying by cash. Cash pay patients can work with us to develop an all-inclusive cost plan that makes sense for them. Further, many of the requirements that insurance companies impose on our patients are no longer applicable. We still follow ALL of the guidelines, evaluations, and testing clearance with the exception of waiting months for surgery. Patients can often get from consultation to surgery in about two months.

Before considering cash pay, however, it is important to understand why the pre-approval could not be processed. It may be something as small or it may be substantial and permanent. Either way, it is important to know.

What to Do If You’re Denied?

A pre-approval does not necessarily guarantee coverage and we will help you in any way possible to ensure that your coverage is not denied. Sometimes, however, patients will receive a denial anyway. This is when you should first contact your insurance provider and request the denial in writing, with the reason clearly stated. Second, bring this denial to our bariatric coordinator and we will help you analyze it and submit a response or appeal. Learn more about what to do when the insurance company denies your surgical claim.

Meeting Others Who Were Once There

You may want to give us a call and we may be able to give you some guidance based on our interactions with other policyholders. You will get some information about how they managed the process and the time it took for them. Most importantly, never feel like you are alone or out of options. There’s always a way to move forward and we are here to help you do just that.

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Advanced Surgical Associates is one of the first exclusively surgical groups practicing in Union County New Jersey. And that is just the first of many firsts for ASA. For over 40 years, we have pioneered breakthrough surgical patient care in North Jersey in both general and weight loss surgery. ASA also offers gastric bypass, gastric sleeve and gastric banding to those suffering from obesity in New Jersey.
© 2020, Advanced Surgical Associates, Bariatric & General Surgery, Springfield, New Jersey