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Can you be denied coverage for gastric bypass if it is medically necessary?
Wiki User
∙ 14y ago
It depends on the terms of the insurance. Read the coverage document to determine if it specifically covers the procedure in question.
ANSWERIf it is deemed medically necessary & your insurance co turns you down you have every right to appeal their decision!
AnswerIf its an exclusion of the policy then it doesn't matter if its medically necessary or not.Wiki User
∙ 14y ago
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Can you claim weight loss surgery?
For the United States, it depends on the coverage provisions of your medical benefits. Generally speaking, unless the weight loss surgery (e.g. gastric bypass, banding) is reviewed and considered medically necessary, then it is not a covered benefit.
Where can I find out more about insurance coverage for gastric bypass?
Your insurance company can discuss insurance coverage for gastric bypass surgery with you. If you have a diagnosis of a weight-related disorder such as diabetes, coverage is common.
can i get gastic band surgery with medical or medicare insurance I also have scan?
Medicare pays for gastric bypass surgery only if it is deemed medically necessary.
Will anthem healthkeepers cover gastric bypass?
Anthem Healthkeepers may cover gastric bypass surgery if it is deemed medically necessary and meets their specific criteria for coverage. You would need to review your policy or contact Anthem directly to determine the coverage details and any potential requirements or restrictions that may apply.
What is a gastric bypass medicaid?
Gastric bypass is weight reduction surgery. To qualify for madicaid coverage in receiving a bypass surgery one must be considered fully disabled without surgery.
Gastric Bypass Surgery Prices and Coverage?
Gastric bypass surgery prices are becoming more affordable. There may be little or no cost if the surgery is deemed medically necessary for qualified people. More insurance companies are covering gastric bypass surgery cost because of the proven benefits of the weight loss such as treating high blood pressure, diabetes, and other health conditions. Cost varies from state-to-state and insurance plan, but the cost typically varies from $15,000 to $35,000 for uncomplicated cases. Some hospitals have payment plans if the surgery is not covered by insurance.
What is the average cost of gastric bypass surgery in the United States?
Most insurance companies have criteria for gastric bypass coverage. This might involve BMI, other medically supervised weight loss attempts, doctor recommendations. Insurance companies do not deem what is "medically necessary." Doctors do that. Insurance companies determine what they will and will not cover, and it's up to the insured to determine what plan is best for his/her needs. There are various bariatric procedures. Expect to pay $15K-$35K depending on the procedure, location and whether the surgeons have a dedicated center or require hospitalization in a general facility .
Will Insurance Cover Gastric Bypass?
When most people decide to turn to gastric bypass surgery for weight loss, the first question the ask is whether the costs are covered by their insurance company. Insurance coverage for gastric bypass varies by insurer, with some insurers placing many conditions in place before they will approve of the procedure. If your gastric bypass surgery is being performed to prevent a potentially fatal disease such as diabetes or heart failure, insurance plans will usually cover it. Insurance coverage for gastric bypass that is more cosmetic in nature is usually more difficult to secure. Your insurer may require that you enroll in a weight loss plan first. Find out more about insurance coverage for gastric bypass from your insurer.
Will state medi-cal health program pay for gastric bypass surgery if medically necessary?
it depends on the state you are living in California medi-cal says no but if you join health net they cover it with your doctors recommendations
Paying the Bill: Gastric Bypass Medicare?
Gastric Bypass Surgery is an elective surgery that morbidly obese patients receive in order to resize the stomach pouch and in turn cause them to consume less food. This type of surgery is extremely costly and patients often require help from their health insurance company. Patients who are on Medicare are sometimes granted coverage for the surgery is they meet certain criteria. Medicare patients must submit a form from their psychician stating that the surgery is medically necessary or that the surgery is necessary to correct an illness that was caused by the patient's obesity.
Review of the Cost Gastric Bypass Surgery?
The cost gastric bypass surgery varies by procedure, geographic location, the surgeon and hospital, as well as if the procedure is done inpatient or outpatient. Gastric bypass surgery generally ranges from $18,000 to $35,000, while some gastric banding surgeries can be as little as $16,000 to $25,000. The physician will need to send the insurance company information showing the procedure is medically necessary so that it is covered, either in full or in part. Consult the insurance company as well as the facilities that are being considered to get an overview of the cost.
Will gastric bypass acceptable with medicaid?
Whether Medicaid covers gastric bypass surgery depends on the specific state and its Medicaid program. Some states may cover it while others may not. It is advisable to check with your state Medicaid office or your healthcare provider to get accurate and up-to-date information about coverage for gastric bypass surgery under Medicaid.
