Insurance Information

For Gastric Bypass Surgery

Gastric bypass and sleeve gastrectomy surgery usually require a one- or two-day hospital stay and two to six weeks of recovery time, depending on the type of work you do. There are many insurance companies that cover bariatric surgery as a benefit, depending on the type and terms of the policy you have. Even when the same insurance company issues them, insurance policies may vary.

Patients may choose to pay for the surgery on a self-pay basis. You can arrange this by calling the Wellington Weight Management Center. Separate fees will apply for the surgeon, pathology and your hospital stay.

Determining Medical Necessity

Insurance coverage depends on whether your primary care physician, surgeon and sometimes a specialist determines that bariatric surgery is medically necessary to reduce significant medical risks to your life.

A thorough medical history, a detailed diet history for the past two consecutive years under medical supervision, current height, weight and body mass index (BMI) and a list of all co-morbidities that are or may be caused by your morbid obesity must be included in a letter of medical necessity written by your primary care physician and provided to Wellington’s Weight Management Center for submission to your insurance company. This letter, along with a psychological evaluation and clearance is a requirement for all insurance companies.

Insurance Denials

There are insurance policies that do not cover bariatric surgery. If you receive a denial of coverage by your insurance company, in some cases, providing additional detailed information in an appeal letter may result in a denial being overturned. A letter of medical necessity does not automatically overrule insurance policies that do not cover bariatric surgery.