Medical Health Insurance For Weight Loss Surgery

As with any insurance policy, Medi Cal covers the cost of certain procedures, even weight loss surgery. However, it is important to understand that there are limitations. In fact, Medi Cal doesn't cover the surgery at all. However, the plan does cover some hospital visits and other expenses for surgery. This article looks at the specifics.

Medi Cal allows hospitals to bill patients for "weight loss surgery" if the patient has a documented weight loss. But, these costs can vary greatly from hospital to hospital. And, the bill will be paid even if the patient has not lost any weight at all. The only time this type of weight loss surgery covers by Medi Cal is when a doctor prescribes it as a pre-operative treatment to remove fats from the abdomen.

The law doesn't require that a patient who wants to have weight loss surgery list it as a condition to receive the coverage. However, the hospital must state in the patient's application that he or she has this condition. It must also state that the patient intends to have this type of procedure. Also, the policy requires that the weight loss surgery is done only during an "operational period" and only if the patient is monitored and exercises and monitors well. So, Medi Cal doesn't cover it all.

Another limitation is that Medi Cal doesn't cover the costs of medications needed for post-operative care. In order to recover fully from weight loss surgery, patients usually need to take prescription medications. These can include medications for cholesterol and blood pressure. Many of these types of drugs can be considered "inactive" medicine because they have not been approved for weight loss. So, they are not covered when taking them as a part of your Medi Cal plan.

And if your surgery requires hospitalization, you may have to pay for the cost of a facility of your choice. This may be different for each plan, so contact your health plan administrator to determine what is available in your plan. (In some states, the facility and doctor's office are the same entities covered by a single plan.)

Another issue that may come up is how Medi Cal works if you lose a lot of weight in a short period of time. In many plans, the maximum amount that you can use in a year is zero dollars. If you do lose a substantial amount of weight during a short period of time, you may qualify for a maximum payment that is greater than the annual maximum you would pay under your Medical plan. The administrator of your Medi Cal plan may provide you with options that will help you pay for your expenses while you are in the hospital after losing the weight. But, you may need to settle for the annual maximum, because you may not be able to get the financial assistance you need during your recovery.

If you lose a substantial amount of weight quickly after you leave the hospital, you may not be allowed to get back on the plan right away. Your plan administrator may explain this to you when you decide to go back on the program. (And you should be aware that this could change due to other circumstances or if you decide to change medical issues or surgery later in your life.) The administrator can also help you make the best decisions about your future finances, including whether you should use a credit card or loan after surgery.

As with any other insurance policy, you should always shop around to find the best deal. Compare not only the costs and premiums of various plans, but also the terms of the policies. You may be able to save money by choosing a high deductible insurance plan. Also, you may be able to reduce your costs by getting extra coverage for your hospital expenses, prescription costs, recovery time and more. Talk to a qualified insurance representative - often called an "assistant" or "counselor" - who can explain how weight loss surgery is handled through Medi Cal.