Insurance question

[Jpsl1028 7]

I have Amerihealth Northeast Caritas. One of their requirements is that I be an acceptable operative risk. My question is what does that mean and who decides that? Must that be done prior to submitting for approval? Also, has anyone used Amerihealth for weight loss surgery? Thank you! Have a wonderful day

[elforman 234]

That's a standard term to mean that the insurance company believes you're worth spending the money on.

Mostly they want to make sure that your risk of recidivism is low, that you know what you're getting into and how to take care of yourself post-op. That's why there's a psychiatric exam requirement before you can be approved. Most people do just fine with that, though in some cases the psychiatrist may feel there is some previously undiagnosed or untreated depression that could affect your health.

There are also other factors, such as if you have other severe medical conditions like advanced cancer, are you likely to actually benefit from WLS? They balance that against the cost of leaving you untreated and instead paying for all of the complications that could arise, such as diabetes.

Bottom line is unless you have an extreme situation either physically or mentally, you'll be fine.