Your insurance may say no at first. Keep appealing and give all records to prove you need the second surgery. Know your insurance’s rules for covering the second surgery.
When Revisions Are Medically Necessary?
Getting your health insurance to pay for a second weight loss surgery requires showing it is truly medically necessary. Revisions may be covered if your first bariatric surgery caused serious health complications. Complications like severe nutrient deficiencies, infections, or hernias may show medical need.
Revisions can also be considered necessary if your initial weight loss surgery did not work as it should. Reasons can include not losing enough weight for health despite doing everything right. Or regaining too much weight back too quickly after losing initially.
To prove medical necessity, your bariatric surgeon must show clear records detailing:
- Your pre and post-surgery weight history
- Complications from the first surgery
- Impacts of these issues on conditions like diabetes or sleep apnea
- Predicted improved outcomes from the revision
The key is having a doctor confirm that just diet and exercise alone cannot fix the issues or failed results. This shows why putting you through another surgery is vitally important for your health.
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5 Steps to Gain Insurance Approval for Revision Bariatric Surgery
Here are five key steps you can follow to get approval for Bariatric Surgery again:
1. Get Detailed Medical Records
Have your bariatric surgeon document exactly why you need a revision, including weight statistics, complications from the initial surgery, and the expected improved outcomes.
2. Check Your Insurance Policy
Understand if and when your insurer covers revision surgery. Look for any BMI guidelines or stipulations on complications coverage specifically.
3. Pre-authorization
Ask your insurance provider if they require specific pre-authorization or referrals from your primary care doctor before deeming revision surgery medically necessary.
4. First Claim Denial Expected
Expect your first claim request to be denied and be prepared to appeal. Start compiling supplementary records and letters as soon as possible.
5. Appeal Persistently
Appeal each claim denial by highlighting reasons the revision is mandatory for your health and recovery. Get personal letters from friends and employers also. Don’t give up!
FAQs
Does Health Insurance Cover Bariatric Surgery in USA
Yes, health insurance typically covers bariatric surgery in the USA
How soon can I get revision weight loss surgery covered by insurance after the initial one?
You typically need to wait 18-24 months to prove the first surgery failed on its own over time for weight and health issues.
Will insurance cover a revision if my first bariatric surgery was done without insurance?
Usually not unless you have clear documentation from your doctor that revision is now medically necessary due to major complications or no weight loss at all.