Bariatric surgery in Maryland is often covered by insurance provided you meet certain eligibility criteria. Insurance companies are frequently changing their coverage criteria and have multiple medical plans, so please call your insurer’s member services number and confirm current requirements and eligibility for bariatric surgery coverage relevant to your case.
It’s important that you fully understand what “is” and “is not” covered by your insurance provider, however, do not attempt to get authorization for surgery yourself or ask your Primary Care Physician to do so. This must be done by our office staff in order to meet all coverage criteria. Here are some helpful hints to assist with the authorization process:
The insurance company will typically ask for the following information and documentation (Please be prepared to assist us with providing these upon request):
If we have submitted an authorization for surgery requests and it was denied, we have the right to appeal the decision on your behalf. Being denied coverage for surgery happens to some patients and this initial set back does not mean that you’ve reached the end of the road. Some insurance providers may initially deny bariatric surgery claims automatically the first time they are submitted, and can be more receptive to follow-up appeal letters and peer-to-peer reviews with medical directors.
If you have questions about the insurance process, please don’t hesitate to contact our office.