Friday, April 12, 2024

How To Get Insurance To Pay For Weight Loss Surgery

Does Medicare Cover Bariatric Surgery

Insurance and Other Payment Options for Bariatric Surgery

Medicare covers some weight-loss surgeries, including laparoscopic banding surgery and gastic bypass surgery.

You need to meet requirements and deemed severely obese. You and your doctor need to get pre-approval for weight-loss surgery.

Similar to other insurers, Medicare will likely require a BMI of at least 35, your weight must also be causing serious health issues and youve attempted for years to lose weight through diet and exercise.

Why Does It Take So Long To Get Insurance Approval

After we submit the letter of pre-determination, most insurers have a standard time that they are allowed to process a non-emergency request, usually up to 30 days. Most insurers take the maximum time.

Were familiar with the criteria and guidelines of most insurance plans and, if necessary, well research your insurers requirements. But we encourage you to get involved in the process and call your insurance company regularly about your request. If you have questions, please call your carrier. When we hear from your insurer, well contact you right away.

Tips For Creating A Successful Weight Loss Surgery Fundraiser

Follow these top medical fundraising tips so you can raise the money you need when you need it most:

  • Connect with your donors by telling your campaign story. Share your challenges, and be open and honest with donors about how funds will help impact your life.
  • Share your fundraiser on social media, and ask your friends and family to share your GoFundMe link on their own accounts.
  • Reach out to your personal network offline for fundraising without social media. Use texting, calling, and talking in person as a way to connect with donors in a more meaningful way.

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Amerigroup Bariatric Surgery Requirements

If you want to know how do I get approved for weight loss surgery through AmeriGroup, you must be able to meet the following criteria:

  • You must be 18 years of age or older.
  • You must have a BMI of 40 or higher.
  • You must have a BMI of 35-39, and at least one obesity-related illness, including diabetes, hypertension, and sleep apnea.
  • You must have proof that you participated in a weight loss program for at least 6 months in the last 2 years.
  • You must have a written letter from your primary doctor recommending the weight loss surgery.
  • You must a complete psychological evaluation that shows you are capable of modifying your behavior for lasting weight loss.

Does health first insurance cover weight loss surgery? Lets see.

Best Health Insurance For Weight Loss Surgery

Will Health Insurance Pay For Gastric Bypass Surgery

The best health insurance for weight loss surgery is the one that suits your unique requirements and fits your budget most closely. Preferred Provider Organization and Health Maintenance Organization are two primary weight loss insurance plans. Leading hospitals and bariatric centers will accept most of the PPO plans and select HMO plans.

  • Insurers: Major insurance companies offering some of the best health insurance for weight loss surgery include Anthem Blue Cross Blue Shield, Aetna, Tricare, Cigna, United Health Care, and Oscar. Each insurer will offer different insurance coverage plans, so carefully consider your options and choose the plan that best serves your needs and affordability.
  • PPO vs. HMO: Both PPO and HMO plans have their own unique hospital and doctor network to help you obtain the best quality of care for your weight loss surgery covered by insurance. With an HMO plan, you will have to go through a referral from a primary care physician. The PPO plan offers you more flexibility and you can choose any hospital or doctor on your own.
  • Coverage: Sometimes the best health insurance for weight loss surgery may not be automatically available when you buy a policy. At the time of purchasing your policy, remember to ask: Does insurance cover weight loss surgery? Your insurer may give you an option to include bariatric surgery insurance as an added benefit for a slightly higher premium.

READ THIS: Does Blue Cross Blue Shield cover weight loss surgery?

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Find Weight Loss Surgery Financial Help Today

No matter your reasons for considering a procedure, there are many resources to help you meet your goals. Countless individuals have used GoFundMe for medical fundraising to help cover costsbecause the investment in your health and quality of life is well worth it. Tap into the power of medical crowdfunding today so you can live your healthiest life. to start your fundraiser and raise money for your bariatric procedure today.

Can You Be Denied For Bariatric Surgery

Background: Many patients who seek weight loss surgery are denied an operation because of insurance barriers, psychological concerns, and poor medical fitness for surgery. Objective: The aim of this cohort study was to study the causes and outcomes of selected patients denied metabolic and bariatric surgery .

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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

How To Pay For Bariatric Surgery Without Insurance


The cost of weight-loss surgery depends on a number of factors, including your location, the hospital, the surgeons fees, and the type of procedure. According to Obesity Coverage, a bariatric surgery information site, the average cost of lap-band surgery is $14,500, while gastric bypass costs an average of $23,000.

The price tag might be gulp-inducing to you, and thats understandable its more than some new cars cost. However, it can be well worth the investment. The American Society for Metabolic and Bariatric Surgery reported that weight-loss procedures could help prevent major health issues and extend your life span.

Bariatric surgery is one of the few cases where going into debt is a good idea because of what it can do for your health and happiness. Thankfully, there are six financing options available to help make the cost more manageable.

Also Check: Recovery Time From Bypass Surgery

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?

Do American Insurance Companies Pay For Weight Loss Surgery

According to the Affordable Care Act, any plan offered on the open exchange must cover bariatric surgery. However, there are still some insurance companies that do not cover bariatric surgery because they are sold off the open exchange.

If you did not purchase your insurance through this exchange, speak to your provider to find out if they offer coverage. Also, keep in mind that even if they will pay for bariatric surgery, insurance companies require you to meet specific criteria before they will pay and often do not cover costs in full.

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How To Pay For Weight Loss Surgery: Think Of The Roi

Bariatric surgery is an investment in your health. Due to the many conditions that arise from long-term obesity, you can expect lofty medical expenses as you age if you dont address your weight. This is an important point to consider when analyzing the costs of weight loss surgery.

The average costs for medications for type 2 diabetes, including prescriptions, insulin pumps, and other associated care, can reach thousands of dollars every year. Its been shown that bariatric procedures such as gastric banding or duodenal switch can lead to the remission of diabetes.

Weight loss surgery can also help with sleep apnea and the costs associated with that disorder. Medicine, CPAP machines and maintenance, and other financial considerations can be a thing of the past with the help of bariatric procedures. In the long run, if you can lose weight through bariatric surgery and keep the weight off, you will save money.

A study published in Bariatric Times stated the following, in regards to the financial ROI of pursuing bariatric surgery:

Top Ways To Get Financial Help For Weight Loss Surgery Costs

How to Pay for Bariatric Surgery Without Insurance

If youve ever tried to lose weight, you know how frustrating and difficult the process can be. More and more people are turning to weight loss surgery to help them live healthier lives, but the high price tag still stands in the way for many. If weight loss surgery costs are a barrier for you, learn how you can pay for the medical procedure so you can begin focusing on a healthier future.

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How To Get Approved For Weight Loss Surgery In Mexico

Since weight loss surgery costs around $15,000 $30,000+ in the US, more and more patients are heading over to Mexico to receive the procedure. Statistics show that almost 1.4 million Americans crossed the border in 2018 to undergo medical treatment including some form of bariatric surgery.

If your insurance carrier is refusing to cover your bariatric procedure and youre wondering how to get weight loss surgery approved in Mexico, here are some simple guidelines for you:

You have to meet the following criteria to be eligible for weight loss surgery in Mexico:

  • You must have a body mass index of 30-35
  • You must have BMI for gastric sleeve of 35-40+
  • You must be suffering from obesity-related illnesses like diabetes, breathing issues, heart problems, hypertension, etc.

Bariatric surgery in Mexico costs around $3,599 $5,500 for inpatient treatment. This means everything from ground transportation and hotel stay to cost of medications is included in this price tag. However, if you cant afford to pay for the surgery all at once, our Jet Medical Tourism® team can provide you with super affordable payment plans as well.

Gofundme Success Stories For Weight Loss Surgery

Asking for help to pay for expensive medical treatments isnt always easy, but you may be surprised by how many friends and family members are willing to step up and lend a hand. Surgery could save your life, and those who care about you will be more than happy to contribute. See how others are using the power of crowdfunding to reach their weight loss goals:

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Tricare Weight Loss Surgery Coverage

Tricare provides coverage for bariatric surgeries but you must meet the necessary qualifications. Please talk directly to a Tricare representative to find out does Tricare cover bariatric surgery.

If you are covered, you must meet the following criteria:

  • You must be 18 years of age or older.
  • You must have a BMI of greater than 40.
  • You must have a BMI of 35-39.9, and at least one of these diseases: diabetes, severe sleep apnea, hypertension, or cardiovascular issues.

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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What Should I Ask My Provider About Weight Loss Surgery

Ask your insurance company if the following procedure codes are covered benefits:

  • CPT Code 43644 laparoscopic Roux-en-Y gastric bypass
  • CPT Code 43775 laparoscopic sleeve gastrectomy
  • CPT Code 43770 laparoscopic adjustable gastric band

Many insurance companies require documentation of medical conditions and medical treatment by your primary care doctor in order to establish whether you meet their weight loss surgery criteria. Your primary care physician may need to generate the authorization. Some insurance companies may also require that you have one or more of the following completed in order to approve surgery:

  • Bariatric psychiatric evaluation
  • Primary care physicians documentation regarding co-morbidities , arthritis or sleep apnea)
  • Primary care physicians documentation of previous weight loss attempts

Henry Ford Hospital has a bariatric surgery insurance specialist who will work with you to obtain insurance authorization. Our insurance specialist, Ann, can be reached at 916-9248.

Tips On How To Get Insurance To Pay For Bariatric Surgery

Weight loss surgery is a vital treatment option for patients suffering from morbid obesity or co-morbidities related to excess weight. A choice for nearly 200,000 people every year, this effective procedure can be life-changing for patients in need.

Despite the advantages to overall health and well-being, however, there is one large concern that can stand in the way of a successful procedure: cost. All surgeries, including gastric bypass and other weight loss procedures, can be very expensive and many patients do not know how to get insurance to pay for bariatric surgery.

If you need assistance covering the costs of your upcoming treatment, these pointers can help you best evaluate your options to pay for some or all of your weight loss surgery.

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I Am A Member What Do I Do Now

The first step is to call Vitality Health to check you are covered under your policy and get an authorisation code from them. This authorisation code will entitle you to come and see us at our Bariatric Centre, The Sudbury Clinic in Harrow, Middlesex .

Once you have your authorisation code just call us on 0333 016 2929 or call 0333 016 3030 to make an appointment. You will need to have a credit or debit card handy to pay the £50 co-pay fee for your consultation. We will arrange an appointment for you at the next available Vitality Clinic. These usually run once a month.

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John is the editorial director for, and Before joining QuinStreet, John was a deputy editor at The Wall Street Journal and had been an editor and reporter at a number of other media outlets where he covered insurance, personal finance, and technology.

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At, we are committed to providing honest and reliable information so that you can make the best financial decisions for you and your family. All of our content is written and reviewed by industry professionals and insurance experts. We maintain strict editorial independence from insurance companies to maintain our editorial integrity, so our recommendations are unbiased and are based on a comprehensive list of criteria.

Even if your body mass index classifies you as morbidly obese that doesnt mean your health insurance company will approve bariatric surgery. Its more complicated than that.

Theres no doubt that Americans are getting heavier. According to the Centers for Disease Control and Prevention, adult obesity rates doubled in the past 30 years. Nearly 40% of adults are considered obese. At least 20% of adults in every state are obese.

Bariatric surgerys benefits far outweigh the risks. Surgery can increase life expectancy by up to 89%, according to Insure.coms 2021 report. And after surgery, patients fare far better than they would have without it.

  • High blood pressure

Key Takeaways

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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.

Can Getting Weight Loss Surgery In Mexico Save Me Money

One option that some people consider is getting weight loss surgery done in Mexico. The cost savings could be significant. For example, a gastric sleeve procedure in Mexico might only cost $5,000 compared to $20,000 in the United States. And for this price, you get everything you need for your procedure, including transportation to and from the airport or land crossing and your hotel and food.

If you are worried about getting the surgery you need covered by your insurance or cannot afford the out-of-pocket costs, contact Hospital BC to learn about weight loss surgery in Mexico.

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