Authorization
for surgery may be denied for reasons that are
specific to the health insurance plan being provided
by your employer. Most commonly they are the
weight loss surgery benefit does not exist; has
been excluded from your policy or the documentation
submitted for authorization does not meet the
criteria required as medically necessary; such
as 3 to 6 months of physician-supervised dieting
or 5 year history of morbid obesity as documented
by a primary care provider with a date range.
Insurance payment
may also be denied for lack of "medical
necessity." A therapy is deemed to be medically
necessary when it is needed to treat a serious
or life-threatening condition. In the case of
morbid obesity, alternative treatments - such
as dieting, exercise, behavior modification,
and some medications - are considered to be available.
Medical necessity denials usually hinge on the
insurance company's request for some form of
documentation, such as participation in a 6 month
to 1 year physician-supervised dieting program
and/or a psychiatric evaluation, illustrating
that you have tried unsuccessfully to lose weight
by other methods. |
