Getting Insurance to Cover Your Bariatric Surgery

By providing the Franciscan Midwest Bariatric Institute with some information about you and insurance policy, you can help speed up the approval process and begin preparing for bariatric surgery.

Getting Insurance Coverage

  • Check out your insurance policy. Find out if your policy covers bariatric surgery for morbid obesity. Some insurance companies have Web sites where you can find this information. 
  • Call your insurance company. You can help speed up the approval process by calling your insurance company before you call us.  Write down the name and phone number of the person you speak with at your insurance company so that our staff can follow up on the information they give you.
  • Copy your insurance card. This will assist us with a preliminary insurance verification check and verification of any co-pays and deductibles that are in your policy.
  • Find out if you need a physician referral. If your insurance requires, you will need to get a referral from your primary care physician. Please remember that having a referral from your doctor to our program does not guarantee approval of your surgery. If specific dates are required, please call our office.
  • Talk to your family doctor about bariatric surgery. If you do not need a referral, you still need to inform your family doctor that you are seeking this procedure. We may need to contact him or her during the approval process.
  • Once we have a referral, we will set up an appointment for a consultation with the surgeon. If he or she agrees to proceed, we will start the approval process.
  • Franciscan St. Margaret does not guarantee that your insurance company will approve you for surgery. We will aggressively pursue getting approval once you become a patient of ours, but ultimately the decision lies with your insurance company.
    • If your insurance policy has exclusions or denies you, meaning it will not cover this type of procedure, you have a right to appeal this.
    • Not all insurance companies will make exceptions to their policies, but it is worth trying if you can prove medical necessity.  If you want to appeal, the following steps may be useful:
      • Ask your primary care doctor to write a letter to the insurance company as to why he or she considers this surgery as medically necessary.
      • Ask any other doctors you see to write a letter. 
      • Insurance companies must tell you what their appeal process is. Appeals are limited and  must be handled by the patient. Our staff is available to answer questions and guide you through the process.