People may opt for bariatric surgery as a means to lose weight. Following the surgery, they may face challenges while returning to work as well as a risk of job loss. . Those undergoing such surgeries often inquire about the possibility of receiving Social Security Disability Insurance (SSDI) benefits.
People going through bariatric surgery do this to improve their morbid obesity. Once the Social Security Administration finds that your condition has improved, they are likely to terminate disability benefits.
Continue reading for more information on how bariatric surgery can impact disability benefits.
What is Bariatric Surgery?
Bariatric surgery is a procedure that involves surgical operations on the stomach or intestines to facilitate weight loss. These surgeries might help people who are overweight or have tried other ways to lose weight but were unsuccessful. Bariatric surgery comes in various forms.
There are things you should think about after surgery to make sure you heal well and lose weight. Eating well is important to avoid iron or vitamin deficiencies since people who are overweight tend to eat less and have trouble absorbing fats. This makes it more important to have a steady source of income while you recover from the surgery.
Impact of Bariatric Surgery on Social Security Benefits
What is the impact of bariatric surgery on Social Security benefits?
There is no single answer to this question, as it will vary based on the specifics of your case, but here are some things to consider:
The Social Security Administration (SSA) generally expects that a reasonable person would proceed with surgical procedures when their doctor suggests them to alleviate pain or improve function and quality of life.
There are a few cases where this rule does not apply, such as a patient who has a history of failed surgeries related to the same disability or when religious convictions prohibit surgical intervention. Make sure to let your doctor know if the cost of surgery is too high for you.
You may still be eligible for a limited period of benefits from Social Security if your impairment prevents you from working for 12 months or longer, even if your operation is effective and restores your ability to work after a reasonable recovery period.
If your doctor tells you to undergo physical or occupational therapy after surgery, you will have a much better chance of getting better if you follow all their instructions and care. If you don’t follow through with this prescribed treatment plan, Social Security may think you are not a reliable claimant for benefits.
If you are unable to finish any or all of the suggested post-surgical therapy because your insurance will not cover them, it is crucial to inform your doctor and therapists of this fact so they can make a note of it and it doesn’t appear to be non-compliance.
It is in your best interests to stick to your doctor’s orders regarding any pre-operative weight loss or smoking cessation programs they may have suggested. Social Security could argue that you are not following medical rules if you refuse to comply with official instructions and question your commitment to recovery and returning to work.
Does Medicare Cover Bariatric Surgery?
Medicare covers certain bariatric and metabolic surgeries for individuals who satisfy the criteria for morbid obesity.
These criteria include a body mass index (BMI) of 35 or more and additional disorders like diabetes, hypertension, cholesterol, and sleep apnea. In order to aid in weight loss and metabolic wellness, the treatments alter your digestive system.
Medicare does pay for some bariatric surgeries, but not all surgeries that address obesity and its complications. Among the more prevalent surgeries it covers are:
- Roux-en-Y gastric bypass, which reshapes the stomach into a tiny pouch, allowing patients to experience fullness with relatively modest meals
- Laparoscopic adjustable gastric banding, which involves putting in a plastic band that surrounds the top of the stomach and makes a pouch
Qualification for Bariatric Surgery under Medicare
Patients with a BMI of 35 or greater with a co-occurring obesity-related medical condition (e.g., diabetes or cardiovascular disease) are eligible for bariatric surgery coverage under Medicare. Patients will also need proof that previous attempts to manage their obesity have failed, like a counseling program’s documentation or a doctor’s order. Elective cosmetic procedures, like liposuction, are not covered by Medicare.
Short-term Disability Insurance
You may be eligible to receive payments from short-term disability insurance in the event of an accident, sickness, or medically required surgery.
A qualifying procedure is usually one that is directed by your doctor as a necessary treatment for an accident or sickness and is appropriate according to generally accepted standards of medicine. However, the exact definition of “medically necessary” will vary from policy to policy.
The limitations and exclusions listed by each policy will also vary. Some of these are pre-existing conditions, which are illnesses or injuries you’ve been treated for in the last year, self-inflicted injuries, (like suicide attempts), injuries or illnesses you got from using drugs or alcohol illegally (like getting hurt in a car accident while drunk) or more, depending on your policy.
In general, however, many insurance companies will pay for weight-loss surgeries like gastric bypass, bariatric, and lap band surgeries if the doctors recommend they are medically necessary to treat a physical problem.
Should You Purchase Short-Term Disability Insurance for a Planned Surgery?
Many financial counselors advise against purchasing short-term disability insurance, even when it is privately accessible. Premiums are high for a payment that could be as low as 60% of your salary for a set amount of time, which could be any time between three months and a year.
Many people find that self-insuring, or saving up for an emergency fund, is the best way to prepare for temporary limitations or illnesses, like getting back on your feet after surgery.
There are also limits and exclusions for pre-existing illnesses in many short-term disability insurance plans that people buy on their own. Most of the time, this means that if you’ve had surgery or been treated for an illness in the last year, your claims about that illness won’t be covered.
Conclusion
If you have recently undergone bariatric surgery, your Social Security benefits may continue for a limited period of time. However, there are other options you can look into, such as Medicare and short-term disability insurance.
