After you’ve consulted with an experienced bariatric surgeon, and together decided that a gastric sleeve procedure is the best option for you, you’re probably wondering what the next steps are to make sure your procedure is covered by your insurance plan.
Here we’ll discuss how to find out if you are covered, guidelines insurance companies use to determine eligibility, and offer the helpful information you need to get started on a successful weight loss journey!
Are You Covered By Insurance For The Gastric Sleeve Procedure?
Weight loss surgery can be expensive. If you can pay cash for the procedure, it makes getting things faster and easier. The Weight Loss Surgery Center of Los Angeles has affordable payment plans available for your convenience. However, many insurance companies cover bariatric surgery, and it really is worth it to find out if your insurance will cover some or all of your expenses. The good news is that most insurance plans do offer coverage if you qualify!
Not sure if your insurance company covers the gastric sleeve procedure? We can help you find out.
Letter Of Medical Necessity
After your bariatric consult, Dr. David Davtyan and his team will submit a document called a Letter of Medical Necessity (LoMN). This is required by all healthcare and insurance plans and is the first step towards approval. A LoMN will include a statement that you meet the criteria set forth by your insurance provider and should also follow the National Institutes of Health guidelines for bariatric surgery.
A classification of morbid obesity is the most important qualification, as it is a life-threatening condition on its own. A LoMN must include your current BMI, how many years you have been morbidly obese, whether you have participated in any medically supervised weight loss programs, prior weight loss attempts, and comorbidities. Most insurances require proof that you have been diagnosed as clinically obese and meet one of the following criteria:
- BMI of 40
- BMI of 35, with comorbidities related to obesity
- BMI of 30, with comorbidities related to obesity
Preparing For Your Visit To The Weight Loss Surgery Center Of Los Angeles
While some insurance companies will accept a LoMN from your bariatric surgeon, some may require you have your PCP write the letter since they are more familiar with your medical history. The problem is, some doctors are simply unaware of the advancements in bariatric surgery and may advise against it. If you are worried that your primary care doctor will not be on-board with your decision it is vital that you arrived armed with knowledge and determination. Dr. David Davtyan will also provide you with some medical articles written by him and his colleagues supporting your decision. Here are a few tips for talking to your PCP:
- Provide medical records and Dr. Davtyan’s articles from your bariatric surgery consult
- Let them know you are serious and you’ve addressed the risks and benefits
- List all risks and benefits associated with the gastric sleeve procedure, as explained to you by Dr. David Davtyan.
- Don’t be shy: share the research you have done
- Make your PCP aware if you have any life-threatening conditions like high blood pressure and diabetes which may be cured by significant weight loss
- Share your weight loss struggle and the toll it has taken both physically and mentally
- Dr. David Davtyan will be happy to discuss his recommendations with your primary care physician if needed.
What Are Some Common Conditions Related To Obesity?
Obese patients are at a significantly increased risk of developing other medical problems as a result of their weight. You may hear these conditions referred to as “comorbidities,” and they can include
- insulin resistance
- type 2 diabetes
- high blood pressure
- cardiovascular disease
- obstructive sleep apnea
- gallbladder problems
There is also evidence that certain cancers occur with increased incidence in patients who are obese. These cancers include colorectal and prostate cancers in men and breast and gallbladder cancer in women.
Additionally, there are psychologic manifestations of obesity including binge-eating disorder (BED), depression, and anxiety. If you’re severely obese, you likely experience a greater risk of impaired psychosocial and physical functioning which causes a poorer quality of life. In short, any health condition for which weight loss was prescribed as treatment can be considered a comorbidity.
Proof Of Previous Weight Loss Attempts
Your insurance may require additional information for the approval process. Dr. David Davtyan and his team will alert you if additional information is needed. Before submitting your LoMN make sure you have gathered supporting documents that detail all of your previous attempts to lose weight. Typical examples are:
- Records of gym membership fees with dates
- Jenny Craig or Weight Watchers membership fees with dates
- Dated personal weight loss journals
- Dated food journals
- Records of medically supervised weight loss programs
- List of prescription weight loss or weight control medications you have taken
- Records of dietician and nutritionist visits
- Records of counseling or other psychological treatment related to weight loss
How Long Does It Take To Receive Approval For The Gastric Sleeve Procedure?
The time for approval may vary. Dr. David Davtyan and the team at Davtyan Medical Weight Loss and Wellness are here to guide you step-by-step through the insurance approval process.
Our ultimate goal is to help you achieve the best possible outcome with the least amount of stress. Learn more about the gastric sleeve procedure by requesting a complimentary consultation today!
Posted on behalf of Dr. David G. Davtyan MD, FACS, FICS