Bariatric surgery denied: how to appeal
The insurer denied weight-loss surgery despite documented obesity. Complete preoperative documentation per ASMBS guidelines.
Why this denial happens
- Plan excludes bariatric surgery entirely
- BMI threshold not met (commonly 40, or 35 with comorbidity)
- Required 6-month supervised diet not completed
- Psychological evaluation missing
What overturns it
- Complete preoperative documentation per ASMBS guidelines
- Supervised diet log with dates and weights
- Psychological clearance
- Comorbidity diagnoses
Evidence checklist
- ✓BMI history
- ✓Supervised diet log
- ✓Psychological evaluation
- ✓Comorbidity codes
- ✓Nutritionist evaluation
Confirm the plan covers bariatric surgery at all before appealing. Plan exclusions are not overturnable through medical-necessity appeals.
Draft an appeal for a "Bariatric surgery" denial
Free analysis identifies the cited policy and missing evidence. Then a finished letter.
FAQ
What does "Bariatric surgery denied" mean on a denial letter?+
The insurer denied weight-loss surgery despite documented obesity.
How long do I have to appeal?+
180 days from the date of denial for ERISA group plans and ACA marketplace plans. 60 days for Medicare Advantage. Check the denial letter for your specific deadline.
What is the success rate for this kind of appeal?+
Outcomes vary, but medical-necessity and step-therapy appeals overturn at meaningful rates when the appeal cites the insurer's own policy and the chart documents the required criteria.
Other denial reasons
Not legal or medical advice. This page is a self-help resource. You make your own decisions. Strip personal identifiers (name, date of birth, address, member ID) from any document before uploading or sharing. The information here summarizes commonly-published payer policies and federal rules; confirm against your specific plan document and the current denial letter before acting.