Summary: It’s no secret that Americans have an increasingly common problem with obesity and the health complications that accompany being overweight. Every year, over 100,000 obese people seek medical intervention to help them lose weight and potentially save their lives. Even after successful weight loss surgery, patients must then begin the process of dealing with the excess skin that inevitably remains after extreme weight loss. While getting insurance companies to pay for post-weight loss body contouring isn’t impossible, it can be challenging. Here are some things to know that just may help you get your claim approved.
1. Insurance Companies Will Often Cover Weight Loss Surgery
Obesity is considered to be life-threatening by most insurance companies because it’s associated with many dangerous conditions including diabetes, high blood pressure and stoke. Because of these obesity-related risk factors, the cost of weight loss surgery is usually covered by insurers as a potentially life-saving operation.
2. Body Contouring Procedures Are Often Not Covered
Statistically, weight loss surgery is very successful, with most people who have surgery losing a significant amount of weight and keeping it off long-term. However, with massive weight loss comes unsightly and uncomfortable loose skin that simply cannot reshape itself to match the person’s slimmer figure. The only option for dealing with the excess skin is to surgically remove it. Unfortunately, thigh lifts, tummy tucks and other body contouring procedures are often considered cosmetic rather than medically necessary by insurance companies.
3. Quality of Life May Influence Insurance Decisions on Body Contouring
Most insurers will initially deny a claim for body contouring surgery, but there are some factors that could change their minds. Skin removal procedures will sometimes be deemed medically necessary if you and your doctor can prove several ways body contouring can help after weight loss to improve your health and quality of life.
Extra folds of skin that remain on the arms, thighs and abdomen can interfere with your ability to walk, prevent you from maintaining good hygiene and create skin conditions due to chafing and friction between skin folds. Convincing your insurer that your desire for body contouring is not cosmetically motivated, but is essential to your overall wellness, is key to getting claims accepted.
4. Choose a Knowledgeable Surgeon and Staff to Help File Successful Claims
If your ultimate goal is to get body contouring surgery after weight loss covered by your insurer, choosing an experienced and knowledgeable surgeon with an equally experienced and knowledgeable staff is crucial. By working with a physician who has experience getting body contouring procedures approved by insurance companies, you’re gaining an important ally who knows how to approach insurers and convince them the surgery is necessary. It’s equally important that a doctor’s staff be experienced in this arena of insurance negotiations since they’re the ones who will be filling out the paperwork the insurer’s decision will be based upon.
5. Insurance Policies Aren’t Set in Stone and Decisions Vary
Although insurance companies have a set of guidelines they use to decide whether or not to approve a claim, their policies are not set in stone. Communicate with your insurance company and be prepared to submit ample proof to help convince them that body contouring is essential to your overall health. Doing your research, choosing the right physician and communicating effectively with your insurer will increase your chances of getting your body contouring surgery covered.