Why Does the Bariatric Surgery Insurance Process Take So Long?

If you have contacted your insurance company about coverage for bariatric surgery and noted their list of requirements, you might initially be overwhelmed. To be sure, the insurance process is not a quick one. Insurance companies have a stated goal of ensuring that bariatric surgery or weight loss surgery is the best and only option for your particular situation and that means ruling out any other possible treatments for obesity, no matter how low their success rates may be.

For most, that means that surgery will have to wait for between three and six months after their decision to move forward. What takes so long you might wonder?

The first and most time-consuming requirement often imposed by insurance companies is the completion of a medical weight loss program. This will take up the vast majority of your wait time. Medical weight loss is a physician supervised weight loss program during which proper diet and exercise habits are taught with regular check-ins with the physician. Based on the results of the medical weight loss program, patients may be preapproved for surgery.

While medical weight loss may be the most time consuming, it is certainly not the only criteria that you have to meet to have surgery. Preoperative testing (including pulmonary, cardiac and psychological evaluations) ensures that the risks of surgery are acceptable, and there may be various other requirements imposed by your insurance company which can vary between policies.

How to Get Around the Wait?

There’s not much we can do to speed up the approval process when your insurance company is involved. However, spending the time and effort to submit an accurate and complete pre-authorization application is critical to a swift approval. Clerical errors often delay this process by a month or more if the insurance company has to reconsider the application. Expediently undergoing the preoperative testing also helps to ensure a swift process to surgery.

Alternatives to Insurance

If the wait is too long, if insurance does not cover the procedure or you have been denied and your appeal was unsuccessful, there are financing, and cash pay options available to patients to qualify for surgery. Dr. Higa and one of our local Tucson hospitals offer a very competitive cash/self pay price and the details can be discussed with our office. If opting to cash pay your finance the procedure, the time to surgery can be cut dramatically – to a matter of weeks. Of course, while we understand that paying out of pocket can be a significant financial burden, the tangible savings in the form of fewer medications, fewer doctor visits and lower food costs as well as the intangible benefits including more productivity at work, enjoyment of family and friends and greater self-esteem and confidence cannot be overstated.

The first step, of course, is to understand if bariatric surgery is right for you and that can be achieved with a consultation with Dr. Higa. During this consultation we will discuss what procedure may be right for you and whether the benefits of surgery outweigh the risks of the procedure. From there, we will work with you to get all the preoperative clearances and walk you through the weight loss surgery process quickly and efficiently.