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Because every insurance policy is unique, it's important that you thoroughly understand your Certificate of Coverage to know exactly what is and isn't covered through your plan.
Many people find dealing with health insurance companies to be intimidating and are not sure how to even get started. If your Weight Loss surgeon recommends surgery, consider the following:
- Your best resource for how to deal with your health insurance company may be your weight loss program. Many Weight Loss programs have patient advocates who work on your behalf with your health insurance company.
- Read your Certificate of Coverage (COC). A COC describes your insurance policy in detail, including what it covers and what it excludes.
- Write down your weight loss history. Go as far back as you can and include diets and exercise programs. If possible, pull together receipts for gym memberships and weight loss programs.
Assistance is key. It is critical that you work with us to determine the correct approach to appealing a denial. We are here to assist you and to help you adhere to your policy’s requirements.
Write a description of how morbid obesity decreases the quality of your life. Be sure to include details such as difficulty walking, socializing, or maintaining personal hygiene. This documentation can be useful for your weight loss program and health insurance company.
Even if you exhaust the appeals options, you still may have options:
- Independent review board: This is an option available to people in more than 40 states and doesn’t require a lawyer. Judgments usually are issued in 60 days. Check your state’s website for specific filing instructions.
- Arbitration: Some health insurance companies require patients to use a third party—other than the patient’s lawyer and the insurance company—instead of going to court.
- Litigation: This option is expensive and takes a lot of time.
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