Working with Health Insurance
Many people find dealing with health insurance companies to be intimidating and are not sure how to even get started. If your bariatric surgeon recommends surgery, consider the following:
Your best resource for how to deal with your health insurance company may be your bariatric program. Many bariatric programs have patient advocates who work on your behalf with your health insurance company.
Read your Certificate of Coverage (COC). A COC describes your insurance policy in detail, including what it covers and what it excludes.
Appealing a Denial
If the insurance company turns down your request for bariatric surgery, you may be able to appeal the decision. Many people do not take advantage of the appeals process or know of the laws that govern insurance companies in their state.
Work with JFK for Life’s Bariatric Team
Assistance is key. It is critical that you work with your bariatric team to determine the correct approach to appealing a denial. Your bariatric team is there to assist you and to help you adhere to your policy’s requirements.
Possible Options After Appeals
Even if you exhaust the appeals options, you still may have options:
- Independent review board: This is an option available to people in more than 40 states and doesn’t require a lawyer. Judgments usually are issued in 60 days. Check your state’s website for specific filing instructions.
- Arbitration: Some health insurance companies require patients to use a third party—other than the patient’s lawyer and the insurance company—instead of going to court.
- Litigation: This option is expensive and takes a lot of time.
For more assistance, please contact your JFK for Life Bariatric Coordinator.