In this article, we talk about how to get approved for gastric sleeve surgery!
Gastric sleeve surgery is one of the most effective weight loss procedures. Studies show that most patients lose weight rapidly and continue doing so until 18 – 24 months after the procedure. This represents a success rate of about 80 – 90%.
So, why is it hard to get approved for gastric sleeve surgery?
There are so many factors that make someone eligible for gastric sleeve. These factors are physiological and psychological, given the long-term effects of this surgery. So, to get approval and hasten the process, you need to do a couple of things.
What Makes You Eligible for Gastric Sleeve?
Gastric sleeve is usually the last resort after all other weight loss techniques have failed. Moreover, the individual should have met the following:
- Have a BMI of 40 and above – In most cases, you can be eligible if you have significant health problems caused by obesity, such as Type 2 diabetes, sleep apnea, or high blood pressure. For such, your BMI should sit between 35 and 39
- 18 – 75 years of age
- Psychologically ready to make permanent lifestyle changes
These requirements are normally strictly enforced by most surgeons, surgery centers, and insurance companies. Eventually, they affect whether you can get approval for the surgery and how quickly you can get it.
The Insurance Process
The insurance process for bariatric surgery varies between patients, insurance companies, and their policies. This process is hardly short.
The first hurdle to getting a quick approval is how overwhelmed the insurance company is. Companies that are hard-pressed for time rarely handle requests promptly. They have a massive load of pre-approvals that they need to handle daily.
Secondly, most insurance companies want to verify that the bariatric procedure is medically necessary. They will thus put you under a series of tests and, in some cases, three to six months in a medical weight loss program that you must undertake before surgery.
Once you complete these tests, the insurance company will know whether gastric sleeve is necessary or not.
This is different from the common skeptical knowledge that insurance companies create these tests to discourage people from continuing the process.
How Long Surgical Insurance Approval Takes
Most patients get approval for gastric sleeve surgery within 90 days or 12 weeks if no medical weight loss program is required. However, consecutive office visits are necessary throughout the approval process.
This process can take longer if getting the testing and documentation the insurance company needs will take you longer. You can hasten this step by regularly communicating with the company to know what they need at what stage.
What to Do as You Wait
Most people waste time getting pre-approval for a gastric sleeve procedure. That shouldn’t be the case. After your first consultation, the surgeon or medical staff would have communicated what you need to do before the surgery and the entire process that will follow.
So, take this time and start working on your diet and exercise regimen. Start losing a bit of weight and stop smoking. This will improve the success rate of the surgery.
Moreover, once the insurance company issues its approval, you’ll have completed most of your pre-op requisites.
What You Can Do to Shorten the Wait
It’s nearly impossible to push the insurance company to approve your surgery faster. But there are ways you can make the process a bit smoother.
Firstly, be organized. Start the process by making a call to the insurance carrier. You’ll understand what you need to qualify for the surgery. You might also be given a coordinator who’ll help you perform a preliminary verification of the insurance benefits and assist you from there.
Once you’ve understood the documentation and what is expected of you, start compiling it quickly and thoroughly. It can take weeks to have your pre-approval revisited or overturned if it was denied for any reason, including omission.
So, if you are in doubt about anything, contact the surgeon and insurance company for clarification.
What You Can Do If You’re Not Pre-Approved
In some cases, you might not be pre-approved for bariatric surgery, or your policy does not cover it. This can be disappointing. However, you can opt for self-pay. This option allows you to pay by cash, and you can work with the surgeon or surgery center to get a sensible, all-inclusive cost plan.
Even better, self-pay patients are not subjected to most of the requirements imposed by insurance companies. The surgeon or surgery center will still follow all the guidelines, evaluation, and testing clearance, but you won’t have to wait months for surgery.
Some surgery centers may take a few days or weeks before the approval is awarded.
Choose the Approval Option That Fits Your Budget
Having insurance pay for your gastric sleeve procedure is the more affordable option. However, the approval process is the longest. On the other hand, self-pay is more expensive but quicker to get the job done.
So that you make the right decision, please consult with a professional surgeon or surgery center to know whether the wait is worth it, or you can opt for a quicker approval process.
