Wednesday, April 10, 2024

How To Get Insurance To Pay For Bariatric Surgery

Process Of Weight Loss Surgery


The World Health Organization says that therapy is needed if the body mass index is more than 30. An endoscopic gastric balloon is given to people with a BMI of 35 or more. If their BMI is 30 or higher, they have to go through this. Obesity is linked to diabetes, snoring, and high blood pressure, so its important to get help with it. Even if the patient gets the results he wants in practice, he wont be able to keep them for long if he doesnt cut back on calories and exercise regularly. This is because doctors and patients who want to lose weight seriously all agree that endoscopic balloon treatments work.

It was first found to be a bridge therapy for people with a body mass index above 40 who were sure to need surgery but were at a high risk and had poor overall health. This is what endoscopic obesity therapies mean. A gastric balloon procedure must be used to lose a certain amount of weight first. There are improvements in how the lungs and heart work. The risks of anesthesia are going down. The patient is then ready for the operation.

When the patient is ready, the balloon will start to go down, and the procedure will begin. To sum up, endoscopic obesity therapies are recommended for obese people who have other health problems that cant be controlled and for people who need to get ready for surgery.

Bariatric Surgery Insurance Coverage

Even though most healthcare companies cover bariatric procedures bariatric surgery insurance coverage will depend if there is a bariatric surgery benefit on the specific health care plan.

In regards to bariatric surgery health insurance plan coverage we strongly encourage our patients to call their health insurance providers and verify:

  • whether bariatric surgery is covered by your health insurance plan policy
  • what percentage of the facility and physicians bill will be patients responsibility

Our practice currently accepts the following insurance plans:

If you do not see your insurance plan on the list, please, call us we most likely accept it. Bariatric surgery insurance coverage requirements sometimes are hard to understand. Please dont hesitate call the office and our Insurance Specialist will gladly help you to verify your benefits.

What If Your Insurance Company Declines Coverage

If your request is turned down, or if the insurance company agrees to pay only a small percentage of the cost, the door is not closed.

You can write a letter of appeal to the insurance company representative who signed the denial. Before you appeal, make sure you understand your policy completely, and that it does not specifically exclude the weight loss surgery you want.

Also, make sure restrictions were not in place when you first began your contract with the health plan.

Your appeal letter should include:

  • An explanation of why you feel the procedure should be covered
  • A request for a full explanation of why coverage is being denied
  • A request for a copy of the specific statement — taken from the policy or benefits booklet — that explains why your coverage is limited or denied
  • A copy of the denial notification
  • A copy of your doctor’s preauthorization request letter

You may find it helpful to send a copy of your appeal letter to your state’s insurance commissioner or the department of corporations if you are covered by an HMO plan. You can explain that youâre having trouble, and ask for assistance. Your bariatric surgeon can help you with your appeal.

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What States Have Insurance Companies Required To Cover The Cost Of Weight Loss Surgery

As previously mentioned, around half of states in the U.S. require ACA-compliant health plans to cover weight-loss surgeries for patients eligible to undergo these procedures.

This does not apply to private health insurance plans or group health insurance plans. These 23 states offer weight-loss surgery in their Essential Health Benefit in all Marketplace health plans:

Does Bariatric Surgery Insurance Have A Waiting Period

Will Health Insurance Pay For Gastric Bypass Surgery

Yes, bariatric surgery in health insurance has a waiting period of usually 2 to 4 years. Which means, if you want to cover your expenses for bariatric surgery you will have to wait for 2 years from the start of your policy. So, it is always advisable to opt for such a benefit with your first health insurance policy itself.

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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.

How Long Does It Take Medicaid To Approve Weight

Medicaid also allows weight-loss surgeries if you meet criteria, but recent studies show approval make take longer.

Insurers usually take a month to approve weight-loss surgeries. However, wait times for Medicaid approval can take five months or more. During that time, Medicaid will review your records and input from your doctor before making the decision.

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How To Get Weight Loss Surgery Covered By Insurance

The best way to find out if your health insurance covers weight loss surgery is simply to ask. Your insurance very well might cover bariatric surgery as long as certain criteria are met. Often, the criteria required by health insurance companies are the same as whats required to have bariatric surgery in the first place.

Your insurance might request a referral from your primary care doctor, along with other documents that show your health history. Your insurance will probably want to know if youve tried to lose weight in the past, such as through diet, exercise, or prescription medications.

According to Duke Health, you will likely have to meet some or all of the following criteria in order to get weight loss surgery covered by your insurance:

  • Be over the age of 18
  • Have a BMI of 40 or greater, or have a BMI of 35 or greater with a comorbidity such as diabetes or hypertension
  • Diagnosis of morbid obesity
  • Pass a psychological evaluation determining youre emotionally fit to undergo weight loss surgery
  • Dont smoke or fully quit smoking before the procedure
  • Willingness to complete a weight loss plan mandated by your insurance company before or after surgery
  • Well-documented history of weight loss efforts

Even if your policy doesnt cover weight loss surgery as-is, if you can provide evidence to your health insurance company that weight loss surgery is a medical necessity for you, you can likely get coverage.

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States Where Insurance Is Required To Cover Bariatric Surgery


Under the Affordable Care Acts Essential Health Benefits Benchmark Plans, 23 states require that all individual, family, and small group insurance plans cover bariatric surgery. Those states are:

Also under the ACA, in the following three states, bariatric surgery coverage must be offered in at least some policies:

  • Georgia, where a 1999 state law also mandates coverage for morbid obesity
  • Indiana, where a 2000 state law also mandates coverage for morbid obesity
  • Virginia, where a 2000 state law also mandates that coverage for morbid obesity must be offered in at least one plan by each state-regulated health insurer

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Use Modern Tools To Help With Insurance Approvals And Billing

Knowing and consistently applying the latest criteria from each insurance company is critical to ensuring your patients are able to be approved for surgery.. You can further simplify the insurance process for you and your patients by using the latest tools to help tailor the evaluation requirements and streamline the pre-authorization process.

Find out how Wellbes personalized care automation can help you streamline insurance approvals and billing, as well as hundreds of other non-medical administrative tasks.

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Weight Loss Surgery Without Insurance At Jet Medical Tourism

Jet Medical Tourism® makes bariatric surgery affordable and accessible to all. The dedicated and compassionate team at Jet Medical Tourism® will provide you the right solutions for how to pay for bariatric surgery without insurance. You dont have to hurt your household budget and you dont need to get into a debt spiral. To know more about low cost weight loss surgery without insurance, give us a call today.

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B Medical Loan For Bariatric Surgery

A medical loan is another type of personal loan for health care or medical care financing. They are generally called unsecured personal loans. The name unsecured refers to the loan not needing to be secured by your property, which puts a lot of risk on your family.2There are many medical financing companies that provide low-cost medical loans for bariatric surgery that help pay for all medical expenses. Medical loans are extremely beneficial by giving financing options for weight loss surgery to patients without going through a long-term approval process. These medical finance companies act as one-off financers.

In most cases, patients get better interest rates and down payments from their bank although it might be a long process. With medical financing companies, you can be accepted in as little as a day, therefore undergoing weight loss surgery much sooner. Ultimately, medical loans have a faster process because they specialize in health care financing. Make sure to check with your bariatric provider to see if they have a recommended third-party option for medical loans.

Gastric Sleeve Insurance Coverage: Action Points

Will Your Insurance Pay For A Tummy Tuck 2021

Many private insurers will require a âletter of medical necessityâ from a surgeon before they agree to pay for your gastric sleeve surgery. The letter should include information on your height, weight history and BMI, a detailed description of your obesity-related health conditions, your current medications and a detailed description of how obesity affects your daily activities.

Be proactive where you can. Start collecting letters and documentation from all health care professionals who have treated you for obesity-related problems now. Keep detailed records of all your weight loss attempts.

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How Much Does Bariatric Surgery Cost Without Health Insurance

Three weight loss surgery procedures are recognized as safe and effective to lose weight they are the Roux-en-Y anastomosis, sleeve gastrectomy, and Lap-Band®. Each surgery has advantages and disadvantages. The type of procedure selected varies significantly on a persons health needs. For instance, someone who is 200 pounds overweight will need the Roux-en-Y to lose a significant amount of weight.

A person who is around 100 pounds overweight can benefit from a gastric sleeve. The Lap-Band® is a good option too, though it requires constant medical monitoring and refilling and lessening the amount of saline in the band.

Since the Roux-en-Y requires the most significant time under anesthesia, many doctors will forgo that option when a person has medical complications. They opt to use the gastric sleeve instead, which is a quicker surgery that requires less time sedated. These operations are not cheap.

An average cost of a Roux-en-Y is between $25,000 – $35,000. It all depends on the hospital and doctor you select. The Lap-Band® is a bit more economical procedure costing between $15,000 to $20,000. The gastric sleeve is around $19,000.

Clinical Care Teams Committed To You

When you request an appointment with our program, our clinical care team will gather your insurance information and give your insurance company a call to find out your specific bariatric insurance coverage and benefits.

Your clinical navigator will then provide you with all the information you need to make an informed financial decision, as well as provide you with self pay and financing options if requested.

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If Your Policy Does Not Cover It: Seek Partial Coverage

You may be able to get part of the costs paid for by insurance even if weight loss surgery isnt covered. Its all about how your doctor and hospital submit your claims to your insurance company.

For example, there are many non-bariatric surgery reasons for your doctor to recommend:

  • Cardiology exam
  • Psychological exam

These are ordered for many reasons other than bariatric surgery and may be covered as a result. If your doctor submits one of these claims using a weight loss surgery CPT code , your insurance is unlikely to cover it. But if your doctor uses a general CPT code, it probably will be covered.

While this may sound sneaky, it is an ethical practice. After all, these tests will be beneficial regardless of whether you move forward with surgery.

Does Health Insurance Cover Bariatric Surgery

Gastric Bypass Surgery Approval | Medicaid

Most health insurance companies will cover bariatric surgery and other weight loss procedures, but that wasn’t always the case. It wasn’t that long ago weight loss surgeries were considered experimental, and were not covered by most policies. Now, weight loss surgeries are fairly routine and have been effective in improving overall health for participants.

However, each policy has exclusions that you want to look over before scheduling surgery. Its best to review your coverages or call for assistance.

What can you do if you need help losing the weight, but your insurance company wont cover you? You can pay for the surgery out of pocket or switch plans. Consequently, most people who need these operations dont have that kind of money. Many are on disability or have health limitations that prevent them from working. There are other options.

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Insurance Coverage For Weight Loss Surgery

Insurance coverage for obesity surgery varies according to the insurance carrier. Those that cover bariatric, or weight loss, surgery often limit their coverage to certain types of surgery.

Insurance companies that cover bariatric surgery have varying requirements. Some may require medical records documenting that you have medical problems caused by your weight or records of your participation in medically supervised weight loss programs. In fact, many insurers require at least six months participation in a supervised weight loss program within two years of your proposed surgery date.

Our office participates with many insurance plans. But whether we participate or not, our surgical scheduler can work with you and your insurance company to obtain authorization for your surgery. Each insurance plan is unique, and getting authorization for surgery is often a long, labor-intensive process.

Prior to visiting our office, please:

  • Write down the name of the person you speak with, including first name, last name, and direct phone number.

Your insurance carrier may request the name of the surgery and the CPT/ICD-9 codes. Insurance companies use the following codes to identify the type of procedure or surgery:

  • Lap Gastric Banding: 43770
  • Lap Gastric Sleeve: 43775
  • Diagnosis Code for Morbid Obesity: E66.01

When you have a surgery date, it may take another two weeks to two months to obtain approval from your insurance carrier.

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Find A Weight Loss Surgeon


  • 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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How To Get Insurance To Pay For Weight Loss Surgery

Question Below Submitted By:

How do I qualify for weight loss surgery so that insurance will pay for it?

I am a 57 years old with a history of chronic back pain, depression and high blood pressure. I have a family history of diabetes, strokes and osteoarthritis with joint replacements.

My weight is 215 pounds and has been this way for the past 10 years. Physically I do walk, but after doing it I hurt, standing in one place for very long I hurt, and also after sitting I hurt. I do swim for exercise when I can get there which is 30 minutes away.

I eat a good diet and I am not a big eater. My downfall on eating is bread and sweets. So with no children in the house I do not bake. My husband and I eat the same foods and in a years time his cholesterol went down 25 points with no drugs except for dietary supplements.

I do believe if the weight is off I could maintain it and I would feel better. What do you think?

A Discussion Of Your Insurance Options

Does Bariatric surgery require life

At some point, after you have spent a considerable amount of time exploring the option of weight loss surgery, you will need to determine how to pay for the procedure. A growing number of states have passed legislation that requires insurance companies to provide benefits for weight loss surgery for patients that meet the National Institutes of Health surgical criteria. And while insurance coverage for weight loss surgery is widespread, it often requires a lengthy and complicated approval process. The best chance for obtaining approval for insurance coverage comes from working together with your surgeon and other experts.

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Past Attempted Weight Loss

In most cases, insurance companies require that your patient has made sufficient efforts to lose weight before theyll approve coverage for bariatric surgery. This can include completing a medically supervised weight-loss plan developed by the insurance provider or making other efforts to lose weight as recommended by a doctor. Generally, insurers require the program or efforts to last from three to seven consecutive months.

If your patient has been unsuccessful in their weight-loss efforts after this period, they may then be considered a candidate for bariatric surgery. You will likely need to provide documentation of the attempts to lose weight, including dietary and exercise regimens, to gain insurance approval.

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