Paying for Surgery

For many people, bariatric surgery is affordable because it is covered by their health insurance plan. People who do not have insurance coverage for bariatric surgery must pay for it on their own. This is called self-pay or cash-pay. Cynthia, a gastric bypass patient featured in Real Patients’ Stories, paid for her own surgery and considered it a critical investment in her health.

Whether you have health insurance or opt for self-pay, you will need to prepare detailed written documentation. From diet history to co-morbid conditions, this information will come in handy.

How to…
WORK WITH INSURANCE | ADVOCATE FOR COVERAGE | FIND ALTERNATIVE FINANCING OPTIONS

How to Work with Insurance

Working with Health Insurance

Many people find dealing with health insurance companies to be intimidating and are not sure how to even get started. If your bariatric surgeon recommends surgery, consider the following:
Your best resource for how to deal with your health insurance company may be your bariatric program. Many bariatric 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.

For more assistance, please contact JFK for Life. Our staff will be happy to help.

Appealing a Denial

If the insurance company turns down your request for bariatric surgery, you may be able to appeal the decision. Many people do not take advantage of the appeals process or know of the laws that govern insurance companies in their state.

Work with JFK for Life's Bariatric Team

Assistance is key. It is critical that you work with your bariatric team to determine the correct approach to appealing a denial. Your bariatric team is there to assist you and to help you adhere to your policy’s requirements.

Possible Options After Appeals

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.

For more assistance, please contact your JFK for Life Bariatric Coordinator.

Also, Learn How to…
ADVOCATE FOR COVERAGE | FIND ALTERNATIVE FINANCING OPTIONS

How to Advocate for Coverage

Health insurance is one of the most common benefits offered by employers. Large employers often have self-funded health insurance and decide which health services and procedures are covered under their policy.

If this is the case, there are steps you can take if your employer has decided not to include bariatric surgery as a covered benefit.

Meet with a Human Resources Representative
Take time to meet with someone from Human Resources to find out why bariatric surgery is not covered. Share your story and how you believe bariatric surgery will benefit not only you, but your organization as well.

It may be helpful to bring information about the many benefits of bariatric surgery—such as increased energy levels and decreased health issues—which can translate into savings for the employer.

Educate Coworkers
Getting coverage approved by an employer can be a time-intensive process. Take the time to educate your coworkers about the surgery and its importance. By educating your coworkers, you’re not only fighting society’s obesity bias, but you also may find other people interested in bariatric surgery.

For more assistance, please contact your JFK for Life Bariatric Coordinator.

Also, Learn How to…
WORK WITH INSURANCE | FIND ALTERNATIVE FINANCING OPTIONS

How to Find Alternative Financing Options

Few people are able to pay cash up front for bariatric surgery. If you do not have health insurance and would like to have the surgery, you may want to explore alternative financing options.

Medical Loans

Many bariatric programs work with financing companies to offer a variety of loans to patients. Your program coordinator can tell you more about the specifics of the options, such as the length of the loan and interest rate.

Home Equity Loans

Another option that some patients have used is a home equity loan. A home equity loan uses the stake you own in your home as collateral. This option is one that should be pursued very cautiously, because you would be borrowing against your home.

For more assistance, please contact JFK for Life. Our staff will be happy to help.

Also, Learn How to…
WORK WITH INSURANCE | ADVOCATE FOR COVERAGE

Common Concerns

Coping With Surgical Risks and Changes