Payment may be denied because there may be a specific exclusion in your policy for surgical weight loss for the “treatment of obesity.”
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 1 to 5 years of physician-supervised dieting or a psychiatric evaluation, illustrating that you have tried unsuccessfully to lose weight by other methods.
Your employer or human relations/personnel office may also be able to answer any questions you might have regarding your coverage for surgical weight loss procedures.