Working with your Insurance Company for WLS

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What You Need When Working with Your Provider

Insurance provider's name and phone/fax number

Policy Number or Employer's Plan Number

Insurance company patient representative and/or contact person

Insurance company e-mail address

Insurance company Web site address (Many insurance providers

maintain Web sites that include member information, such as coverage

of medical procedures. Sometimes providers may require you sign up

to view certain areas of the Web site. This process may be

confusing. If so, call your provider and ask to be walked-through

the sign-up process.)

Reading Your Insurance Contract or Employer's Summary Plan

Description

What are your health insurance benefits?

What is the definition of morbid obesity according to your plan?

If any, what coverage of morbid obesity is listed?

Is there a maximum dollar limit on your benefits?

What treatment options are excluded or specifically included

(See " Reviewing Your Policy " )?

What is the co-payment for medical services?

What testing is covered, such as nutritionist, psychologist, labs,

sleep apnea study, ultrasounds, etc.?

Does your insurer require weight-loss prior to surgery? If so, what

percentage or number of pounds is required?

What limits and/or requirements are stated in order to receive

morbid obesity treatment? For example:

Is there a certain amount of required time you must document

attempted weight-loss?

Does the documented time have to be consecutive?

Is your physician required to document your weight-loss attempts?

Do you need to weigh a certain amount before treatment is performed

and/or initiated?

Is there an age requirement to receive care?

Must you use a specific Center of Excellence or medical provider to

receive coverage?

Are there weight limitations preventing cover?

Helpful Tips When Speaking with Your Insurance Representative

Do's

Speak slowly and clearly.

Ask for their name and write it down when they answer the call

(request they spell it for you if you are not sure).

Ask for a specific phone number and/or e-mail address from the

representative and write it down.

Ask for a hardcopy of your policy or Employer's SPD to be mailed to

you with the areas regarding obesity and morbid obesity highlighted.

If you are promised or guaranteed anything regarding your policy,

make sure you receive it in writing. This will provide you with

documentation if you experience a claim dispute.

Keep a detailed record of all your documents.

Be persistent.

Don'ts

Refrain from rudeness.

Do not demand anything.

Do not threaten anyone.

Do not get frustrated. If you experience an unpleasant

representative, simply thank them for their time, hang up, and call

back.