Bariatric surgery was denied. How do I appeal?
Bariatric denials usually involve BMI thresholds, documented comorbidities, supervised weight-management history, nutrition and psychological evaluations, center-of-excellence rules, or plan exclusions. Appeal by building a criterion-by-criterion packet rather than a general letter about needing surgery.
What to do, in order
- Step 1
Get the bariatric policy and exclusion language
A criteria denial is different from a benefit exclusion. Read both the medical policy and the plan benefit document.
- Step 2
Build the timeline
BMI history, comorbidities, weight-management program dates, prior treatments, nutrition visits, psychological evaluation, and surgeon notes should be in chronological order.
- Step 3
Fix missing program documentation
Many denials happen because the supervised program note lacks duration, dates, or required provider type.
- Step 4
Address revision surgery separately
Revision criteria often require complication, anatomic failure, or medical necessity beyond weight regain.
The deadline that applies
At least 180 days to appeal on employer and ACA plans. Pre-service surgery appeals are generally decided within 30 days, 72 hours if urgent, but the letter controls.
Calculate your date →Documents to gather
- Bariatric denial
- Plan bariatric policy and exclusions
- BMI and comorbidity records
- Supervised program notes
- Nutrition and psychological evaluations
- Surgeon letter
Go deeper
Related questions
Is a bariatric exclusion appealable?
Yes, but it is harder than a criteria denial. You must argue plan language, covered indication, or legal limits on the exclusion.
Can missing supervised-diet notes be added?
Often yes if the services happened and the provider can document them. Submit the missing records as a supplement.
Does revision surgery use the same criteria?
Usually no. Revision criteria often focus on complications or anatomic failure.
Sources
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