Sunday, April 14, 2024

Can I Buy Insurance To Cover Bariatric Surgery

Other Ways To Pay For Weight Loss Surgery

Does your Insurance cover Bariatric Surgery?

If you do not have health insurance, or if your insurer will not cover weight loss surgery, talk to your doctor and your surgeon about financing plans. Check on the interest rate, and make sure you are OK with all of the terms.

Show Sources

Anita Courcoulas, MD, MPH, chief of minimally invasive bariatric and general surgery, University of Pittsburgh School of Medicine.

American Society of Plastic Surgeons: “Insurance Coverage: A Patient’s Guide.”

American Society for Metabolic and Bariatric Surgery: “Metabolic & Bariatric Surgery.”

WebMD Medical Reference: “Preparing for Weight Loss Surgery” and “Your Options in Weight Loss Surgery: Making the Choice.”

National Conference of State Legislatures: “Health Reform and Health Mandates for Obesity.”

Weight Loss Surgery Insurance Secrets

When you have made the big decision to achieve permanent freedom from obesity, nothing should come in your way to qualify for weight loss surgery insurance. However, in reality, many patients experience challenges in getting approvals or face claim denials from their insurers. Here are five proven weight loss surgery insurance secrets that will help you obtain approval for maximum coverage from your insurance company.

CHECK THIS TOO: Self pay bariatric surgery near me

You Can Afford Weight Loss Surgery

When you have obesity-related health problems, you can achieve weight loss effectively through bariatric surgery. However, one of the most common reasons people dont pursue weight loss surgery is finances. But you may be surprised how affordable weight-loss surgery really is. We have some insight on how to pay for weight loss surgery without sacrificing the quality of care.

It is important to know that bariatric surgery can be life-changing and, in some cases, lifesaving. The key here is to take steps towards your health by taking advantage of financing options available to you. We believe that anyone who requires weight loss surgery should have the opportunity to pay for it.

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What Are The Documents Required To Avail Bariatric Surgery In Health Insurance

What is required is a documented detailed history of your obesity-related health problems, difficulties, and treatment attempts demonstrating that a multidisciplinary approach with dietary, other lifestyle modifications , and pharmacological therapy, if appropriate, have been unsuccessful, at least for past 6 months.

Gastric Sleeve Insurance Coverage: Action Points And Other Options

Choosing a Bariatric Surgeon: What to Consider

Many private insurance companies will require a letter from a doctor from a doctor before they will pay for the gastric sleeve procedure.

The letter should contain information about your height, weight background, and BMI, an in-depth description of your health issues due to obesity, including your current medications, and a comprehensive description of how being overweight affect your daily life.

Take action wherever you can. Begin collecting letters and other documentation from all healthcare professionals who have treated you for obesity-related issues right now. Keep complete records of the weight loss efforts you have made.

If you decide to pay cash for your gastric sleeve , the complications might not be paid for by the insurance company. In that case, certain bariatric surgical centers might provide reinsurance programs that take care of the costs associated with complications in the first year following surgery.

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Individual Or Family Insurance

Due to the passage of the Affordable Care Act , insurance companies in 23 states are REQUIRED to cover weight loss surgery for all Individual Plans, Family Plans and Small Group Plans . The updated list below includes all Affordable Care Act weight loss surgery states.

Obamacare Weight Loss Surgery States

To confirm your coverage, you have a couple of options:

  • Option 1 : Your local surgeon will contact your insurance company to confirm your benefits for free . Their office will be very familiar with your insurance companys requirements and approval process, so its usually a good idea to let them do the work for you. .
  • Option 2: Contact your insurance company yourself and/or check your Summary Plan Description . See our page on Insurance That Covers Bariatric Surgery for the full list of United States insurance companies, contact information, and bariatric surgery coverage requirements.

If you find out that weight loss surgery is not covered, you still have several options for financing bariatric surgery to make treatment more affordable and to potentially reduce your out of pocket expenses.

For more information about Bariatric Surgery and the Affordable Care Act, see our Obamacare Weight Loss Surgery Page.

Can Health Insurance Cover Surgery For Weight Loss

Health insurance can cover weight loss surgery however, its not a guarantee. Insurance cover for weight reduction surgery is different depending on the insurance policy. However, the majority of insurance policies allow bariatric surgery, provided that the patient meets the criteria for eligibility,

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Does Health Insurance Cover Weight Loss Surgery

In many cases, health insurance will cover weight loss surgery, but its not guaranteed. Insurance coverage for weight loss surgery varies with insurance policies. However, most insurance policies will cover bariatric surgery, assuming that the patient meets the qualification requirements, according to Dr. Garber. In addition, insurance eligibility for weight loss changes often, so Dr. Garber recommends working with your insurance provider and your bariatric surgeon to determine if surgery will be covered.

What Are The Criteria To Get Weight Loss Surgery Covered By Insurance

Will Insurance Cover My Weight Loss Surgery?

Does my insurance cover weight loss surgery? As with many healthcare services, the answer is that it depends.

To start, every insurance company is different, meaning there are no rigid standards that every company in the country needs to adhere to. That being said, there are some general guidelines that the majority of insurance companies choose to follow, and in some cases, due to state guidelines, must follow.

In general, to qualify for insurance coverage for weight loss surgery, the following criteria must be met:

  • You have a body mass index of 40 or higher OR you have a BMI of 35 to 40, and you also have a serious or life-threatening health complication related to obesity, such as heart disease or high blood pressure
  • You have already tried to lose weight through a medically-approved weight loss program and not had success

Curious what your BMI is? The CDC offers a free BMI calculator for adults. Just enter your height and weight and tap Calculate.

For more information on BMI in general, visit the CDC.

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Private Insurers For Gastric Bypass Surgery

As for private insurers, each company has its own policy on weight loss surgery. The general rule of thumb is that coverage is available for individuals who have a BMI of 40 or higher, or a BMI of 35 or more, together with a weight-related illness.Companies with more than a few hundred employees are more likely to offer coverage for this type of surgery. Individuals who work for smaller companies with only 100 or so employees are less likely to get insurance for their surgery. Talk to the human resources department of your company to get a better understanding of how much financial assistance is available to you.Another point to remember is that most private insurance companies dont approve bariatric surgeries easily they have requirements that people must meet in order to be eligible. Some insurers ask you to provide a letter that details the medical necessity of the procedure written by your primary care physician, together with documentation of any weight-related ailments you have.Get familiar with your insurers appeals policy when youre doing research on the financial aspects of your surgery. If your insurer turns you down, you can always appeal. You can also talk to the bariatric program about financing options, but be aware that not all of these options will cover you in the event of post-operative complications.

  • BARIATRIC ARTICLES & INFO

Life after Weight Loss Surgery

Payment & Insurance Coverage For Weight Loss Surgery

After you have completed all of the steps to prepare for weight loss surgery, our staff at NYU Langones Weight Management Program is able to discuss payment options.

If you are planning to pay for the surgery yourself, known as out-of-pocket payment, please make sure you bring the correct documentation to your first appointment.

If you are planning to have your surgery covered by insurance, you need to complete the authorization process required by your insurance carrier.

NYU Langones Weight Management Program is designated as a CIGNA Certified Hospital for Bariatric Surgery, a Blue Cross Blue Shield Blue Distinction Center for Bariatric Surgery, an Optum Bariatric Center of Excellence, and a HIP Emblem Center of Excellence.

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If You Are Covered By Medicare Or Medicaid

Medicare and Medicaid BOTH cover bariatric surgery as long as you meet their qualification guidelines:

To get approved, youll need to be referred by your primary care physician or other attending doctor . Your surgeon will also need to be in The Centers for Medicare and Medicaid Services directory.

Medicaid Coverage & Bariatric Surgeons

Many surgeons do not accept Medicaid due to lower reimbursement levels .

Contact your local surgeon to confirm whether they will accept your Medicaid insurance. If they dont, ask for a referral to a surgeon who does.

If you have Medicare Advantage, youll need to verify that your chosen surgical team and their hospital are in your insurance companys network. Contact your insurance company directly to find out .

See our Medicaid/Medicare Bariatric Surgery page for more information.

Gastric Sleeve Insurance Coverage: Other Options

How to Appeal a Health Insurance Denial

If you choose to pay cash for gastric sleeve surgery, complications may not be covered. Some bariatric surgery centers may offer âreinsuranceâ plans that will cover the cost of complications during the first year after surgery if you pay cash for your gastric sleeve surgery.

You have options, and discovering them is just a phone call away. Call our Gastric Sleeve Insurance Experts Hotline at or fill out our FREE No Obligation Gastric Sleeve Insurance Verification Form.

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How Much Does It Cost

Weight loss surgery is expensive. Typical costs can run from $20,000 to $25,000, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

The price of your weight loss surgery will depend on several factors:

  • The type of surgery you’re having. Types of weight loss surgery include gastric bypass, adjustable gastric banding, vertical gastric banding , sleeve gastrectomy, and biliopancreatic diversion. Other options include intragastric balloons or even an electric Implant device. Each has a different fee.
  • Your surgeon’s fee. This will vary based on where you live, your surgeon’s expertise, and the procedureâs complexity.
  • The hospital you choose. Costs will vary and may include the operating and hospital rooms, among other fees.

Additional costs may include:

  • Follow-up procedures

Find A Weight Loss Surgeon

SECTION SUMMARY:

  • You can ask a local bariatric practice for a free insurance check or cost quote
  • You can attend a free in-person seminar or an online webinar offered by a local weight loss surgeon
  • You should schedule a phone or in-person consultation , if you are interested in learning more about weight loss surgery

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Insurance Criteria For Bariatric Surgery

Even though each insurance company has their own written bariatric surgery policy and requirements here are some of the most common criteria:

  • BMI over 35 with a comorbidity or BMI over 40
  • Letter of Medical Necessity from your primary care doctor
  • Nutritional Consult or a series of monthly nutrition consults
  • Evaluation from a Psychologist and/or Psychiatrist
  • Documentation of failed medically supervised diet for minimum of two years
  • Medical Clearance completed within 30 days prior to surgery

How To Afford Weight Loss Surgery: Insurance Coverage

Bill Proposes Health Insurance Coverage For Bariatric Surgery

CAN I BUY INSURANCE TO COVER BARIATRIC SURGERY?Some health insurance planslike those you may obtain from your employermay provide coverage for weight loss surgery. This is not always the case, though. You should talk to your health care plan provider to determine the right services for you.

Health insurance may be available to those who do not have any. Purchasing a policy that allows for bariatric surgery is essential. If you are unsure what your insurance options are, talk to a representative from the company. Fortunately, California is one of 23 states that require individual, family, and small group insurance plans to cover bariatric surgery through the Affordable Care Act.

Most people can obtain coverage for bariatric procedures through their PPO or Medicare. Exhaust these possibilities as a first step.

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Should I Use Insurance Or Cash To Pay For Surgery

Insurance is typically the best way to go when you are considering weight loss surgery. However, many procedures are not covered by insurance. Historically, gastric sleeves, duodenal switches, mini-gastric bypasses and other experimental procedures are not covered. Today gastric sleeves, laparoscopic gastric bypass and lap gastric bands are typically covered by most major insurance companies. But this doesnt necessarily mean your policy includes coverage.

It depends on your policy not the insurance carrier.

While most insurance carriers offer some sort of weight loss surgery coverage, your individual policy details whats included and whats not. Some policies specifically exclude weight loss surgery. Most insurance companies charge more to include weight loss surgery coverage. For this reason, you will want to check your policy to see if you have coverage. The best way to do that is to call your carrier directly .

You can also call a couple of local bariatric surgeons and their staff will check to see if you have coverage. Use our surgeon finder to find a bariatric program in your area.

Youre covered!

If you have coverage, then its time to find a surgeon. We recommend attending a couple of seminars and meeting with at least two different bariatric surgeons. This article will walk you through choosing a great bariatric surgeon.

I dont have coverage.

  • Consider a job with amazing benefits. Yes, in some cases it may make sense to look for a new job just for the benefits.
  • How Much Does Gastric Sleeve Surgery Cost

    According to one research, it takes an average of three years from the time you contemplate gastric surgery to the time you actually get it. You may spend many hours studying, reading, and speaking with post-operative patients regarding their procedures.

    But, how much is gastric sleeve surgery? A Gastric sleeve surgery costs an average of $23,000, while a gastric bypass surgery costs $14,500, and sleeve gastrectomy surgery costs $14,900. So, before you get too excited, find out if your insurance will cover weight reduction surgery or not.

    Patients belonging to the middle to upper classes are the majority of people who undergo this surgery. In addition, most people considering weight reduction surgery may not afford to pay the $20,000 gastric sleeve cost to reduce weight.

    However, insurance companies are also beginning to pay weight reduction surgery amounts in more significant numbers than ever before. So, if you are determined to get this even after knowing how much is gastric sleeve surgery, talk to your insurance provider.

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    The Use Of Health Insurance For Bariatric Surgery

    With the high costs associated with Bariatric Surgery, it may lead to the question of using health insurance to cover the cost Either partially or completely.

    While this will change based on each individual health insurance company and coverage, there are usually base requirements to qualify for insured coverage of the procedures.

    Most insurance companies may require:

    • Proof that the surgery is medically necessary
    • Previous participation in physician-supervised diet & weight loss programs
    • A psychological & nutritional evaluation

    If you meet the above requirements, the surgeon can provide your insurance company with a pre-authorization document outlining the necessity of the surgery. Once done, its up to the insurance company to review the case and decide the next steps, whether that be to cover the cost of the surgery, or provide other solutions.

    Which Factors Affect The Cost Of Weight Loss Surgery

    GASTRIC SLEEVE COST

    Costs for weight loss surgery primarily depend on these three factors:

  • Type of surgery. Some weight loss surgeries are more labor intensive than others and therefore end up costing more.
  • Your surgeon. In general, surgeons practicing in areas with higher costs of living will charge more for weight loss surgery. Surgeon experience also plays a role in how much they charge.
  • Location. Hospitals arent just for urgent care. The hospital or operating room you choose to have your surgery at will charge a variable price compared to other similar facilities in your area.
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    How To Meet Insurance Criteria

    Once your benefits have been confirmed, youll meet with a surgeon to consult. Your height, weight and BMI will be documented as well as comorbid conditions and tried and failed attempts at conservative, non-surgical weight management. If your plan requires a medically supervised weight loss program, youll start seeing a dietitian, typically on a monthly basis for the specified duration.

    The most common insurance criteria is a psychological clearance, so you should plan to schedule an appointment with a mental health professional who will evaluate you to determine candidacy for bariatric surgery. It is important to rule out psychological disorders, disordered eating of any type, inability to provide informed consent or inability to comply with pre- and post-surgical recommendations.

    What States Require Insurance Companies To Cover Weight Loss Surgery

    As mentioned, about half of the states in the U.S. require ACA-compliant health plans to cover weight loss surgery for all patients who qualify for these procedures. Keep in mind that this does not apply to private health plans or group health plans. According to Dr. Garber, these 23 states include weight loss surgery as an Essential Health Benefit with every Marketplace health plan:

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