Sunday, April 14, 2024

Weight Loss Surgery Cost With Insurance

How Much Does Weight Loss Surgery Cost

Insurance and Other Payment Options for Bariatric Surgery

The cost of weight loss surgery will also vary depending on your insurance coverage. If your procedure is covered by insurance, you will likely only be responsible for your deductible and any coinsurance or copayments. However, if your surgery is not covered by insurance, you may be responsible for the full cost of the procedure.

The average cost of weight loss surgery ranges from $15,000 to $25,000. However, this price can vary depending on the type of surgery and the hospital or surgical center where it is performed.

Whats Covered In Insurance

If you are lucky to have an insurance plan that covers bariatric procedures, then it is likely youd want to know whats covered in the policy. This may vary depending on your policy type, insurance company, or how much you pay for the coverage. Typically, a health plan will protect your finances by providing a wide range of benefits that include:

  • Cashless hospitalization at any network bariatric center or hospital
  • Daily allowances
  • Ambulance cover

However, there are certain eligibility criteria that you must fulfill to get coverage for your bariatric surgery. Most insurance companies need the individuals to meet the following conditions:

  • The insured must be 18 years old or above
  • The bariatric procedure is prescribed by the doctor
  • BMI of the insured is more than or equal to 40
  • Or the BMI is greater than or equal to 35, but the individual has severe comorbidities like coronary heart disease, sleep apnea, cardiomyopathy, or Type 2 diabetes that require less invasive weight loss methods

How To Get Started With Surgical Weight Loss

To get started with surgical weight loss, youll want to do research and talk with at least two surgeons. If you can, consider attending an in-person or online seminar to learn more about the process.

Also, youll need to see if you meet the criteria of your insurance coverage. This might include having a specific body mass index and obesity-related conditions.

Check to see which hospitals your plan covers. You can also find out whether you need a referral from your primary care physician and provide information regarding your medical history. You may also need to provide evidence that other weight loss methods were not effective.

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How Do You Get Your Insurance Company To Pay For Your Weight Loss Surgery

The first step is to look into your health insurance plan to see the specific criteria your insurance company requires you to meet before they agree to pay for your surgery.

Next, see if you meet the criteria by assessing different factors about you and your lifestyle, such as your BMI.

If you dont meet the criteria, consider changing your plan during the next Open Enrollment Period, assuming you are currently using a plan from the federal Marketplace on healthcare.gov or a state-sponsored Marketplace.

From there, seek out a qualified surgeon that is in your approved network of healthcare professionals. Although some types of health insurance plans allow you to see any surgeon you please, most have restrictions on whom you can see if you want to receive coverage.

Finally, ask your surgeon to double-check that everything is acceptable between them and your insurance company. During this step, you should receive an exact list of costs, including what portion youll be responsible for.

As you go through the steps, you may be required to visit your primary care physician. For example, you may need to get an official BMI reading, or if you suspect you have a certain condition that has been caused by obesity, you may need an official diagnosis of that condition.

Overall, just like with psychiatry and therapy, it is usually possible to get your health insurance company to pay for the majority of your weight loss surgery treatment.

What States Require Insurance Companies To Cover Weight Loss Surgery

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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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Does Insurance Cover Bariatric Surgery

Bariatric surgery can be an expensive procedure, often costing tens of thousands of dollars. In the U.S., many insurance plans cover bariatric surgery when a patient meets certain criteria.

According to a recent survey of coverage criteria for bariatric surgery, 95% of companies have a clearly defined pre-authorization policy. They all covered Roux-en-Y bypass surgery, and most also covered laparoscopic adjustable gastric banding or sleeve gastrectomy.

The majority of insurers required BMIs of 40 and above, or 35 and above with a co-morbidity present, and a supervised medical weight management program prior to the approval of bariatric surgery.

Weight Loss Surgery Costs Insurance Coverage

Bariatric surgery is one of the most popular methods for managing weight loss for individuals that are considered obese. It is the last resort for people that have tried many ways to lose weight but cant.

One concern that most patients have is the cost of bariatric surgery. The costs related to these types of operations vary greatly from surgery to surgery as well as location. Also, the prices could be different depending on the patient and the type of services that they expect.

The average price for bariatric surgery runs from $15,000 to $36,000 depending on the operation type, the location of the professional, and the professionals themselves. The three most popular types of bariatric surgery include Lap-Band surgery, gastric sleeve surgery, and gastric bypass. These three operations require a different amount of surgical techniques.

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Cover For Weight Loss Surgery Vs Weight Management

Cover for weight loss surgery

You’ll only find health insurance for weight loss surgery with a gold-tier hospital policy. If you’re not already on one, you’ll want to get on one soon because there will be a waiting period, usually around 12 months.

Cover for weight management

Many extras policies cover weight management programs like fitness classes, money off gym memberships and nutritional consulting programs such as WW and Jenny Craig. This can give you a chance to learn new wellness habits pre-surgery or, in some cases, avoid having surgery altogether. Waiting periods are a lot shorter usually around 2 months.

Does Medicare Cover Weight Loss Surgery

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Written by: Carol Ballenger

When I was new to the Medicare industry, I would frequently ask what I thought was a simple and straightforward question. Just as frequently, I would be met with the answer, it depends.

With that as a backdrop, here we go: Medicare does cover bariatric surgery, but only for certain patients and only for certain types of procedures.

Lets break it down.

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Is Sleeve Gastrectomy Surgery Covered By Insurance

Gastric Sleeve surgery has historically not been covered by insurance. It was covered if the surgery was part of a staged gastric bypass procedure for the super morbidly obese who could not handle extended surgery times without losing more weight. This was called a staged procedure. The surgeon would perform part of a gastric bypass or a duodenal switch surgery and then once the patient lost some weight and recovered, the surgeon planned on finishing the surgery. However, most patients lost enough weight after the first part of the procedure. And a second procedure was not necessary.

Surgeons started booking more patients as staged duodenal switch surgeries knowing that insurance would pay for the procedure. But they also knew that the patient would lose enough weight and not need a second procedure.

Due to an overwhelming amount of data that showed gastric sleeve surgery caused significant weight loss, more insurance companies have started covering gastric sleeves as a primary treatment for morbid obesity. In 2010, three of the major insurance carriers chose to cover sleeve gastrectomies as a primary bariatric procedure. Since then many other insurance companies are now covering gastric sleeve surgery. Check if your insurance carrier covers gastric sleeve surgery.

How To Get Bariatric Surgery Covered By Insurance

In certain situations, your health insurance may cover the cost of bariatric surgery. In addition, some states are required to cover bariatric surgery if you have an ACA-compliant health insurance plan through the Marketplace.

However, weight loss surgery is not automatically covered by every policy, and for every person. If you want to get your health insurance provider to cover weight loss surgery, heres what you need to do:

  • Check the details of your health insurance policy: The first step is to review your policy details to see if bariatric surgery is a covered procedure. You also can contact your insurance company and speak with an agent, who can walk you through the fine print of your policy and whats covered.
  • Find a surgeon that is in your network: Next, youll want to choose a surgeon who is in your health plan network. Depending on your plan, a portion of the cost may be paid for if you visit an out-of-network provider. However, because bariatric surgery can be very expensive, seeing an in-network doctor will likely reduce your out-of-pocket cost significantly.
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    Which States Require Insurance To Cover Bariatric Surgery

    Weight loss surgeries, generally referred to under the umbrella term bariatric surgeries, make physical changes to your digestive tract to aid in weight loss.

    Although not the only one, gastric bypass is a very common type of bariatric surgery where the surgeon creates a small pouch and connects it to the small intestines.

    Gastric bypass surgery patients are less likely to overeat because the pouch is smaller than the stomach, meaning it gets fulland you feel fullmore quickly.

    23 states require healthcare plans to cover bariatric surgery: Arizona, California, Colorado, Delaware, Hawaii, Illinois, Iowa, Maine, Maryland, Massachusetts, Michigan, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Rhode Island, South Dakota, Vermont, West Virginia, and Wyoming.

    Georgia, Indiana, and Virginia also require healthcare plans to cover bariatric surgery, but only under certain types of plans.

    If youre looking to lose weight but youre not sure if you want to make the leap to weight loss surgery quite yet, your state may require insurance companies to offer a less invasive alternative. 16 states require healthcare plans to include some sort of reimbursement for weight loss counseling, and an additional seven states cover nutritional counseling, but only if a diabetes-related diagnosis has been made.

    Visit the National Conference of State Legislatures for a full list of which states cover which weight loss-related treatment options.

    Your Insurance Options For Bariatric Surgery

    Michelle Before And After Lap Band Surgery

    A growing number of states have passed legislation that requires insurance companies to provide benefits for weight-loss surgery patients that meet the National Institutes of Health surgical criteria.

    Patients who meet this criteria have a body mass index of 40 or more or a BMI or 45 or more with serious health problems linked to obesity, such as Type 2 diabetes, heart disease or sleep apnea.

    While insurance coverage for weight-loss surgery is widespread, it can involve a lengthy and complicated approval process. The staff at the bariatric surgeon’s office are well-acquainted with insurance and can help patients navigate through the process in preparation for surgery.

    There are some key things that you should do to obtain insurance coverage for weight-loss surgery:

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    Can Your Health Insurance Cover Weight Loss Surgery

    Being in control, feeling protected, or gaining a sense of trust are some associated terms when someone thinks about taking out health insurance. Financial backing is a way to care for your future and your family. And those who undergo weight loss surgery in Mexico know that health and the future are closely related.

    Solving obesity in time can be one of the best investments for your present and future health. However, bariatric surgeries are a treatment that is effective when you receive the proper follow-up until you achieve your weight loss goal. For this reason, knowing how to finance the surgery and what the treatment entails during the following months is of great interest. Discover the position of some health insurance in this regard.

    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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    How To Get Insurance To Pay For Bariatric Surgery

    For an increasing number of patients, weight-loss surgery can offer a way to improve their health and quality of life. Forecasts predict that the bariatric surgery market will grow at a compound annual growth rate of 9.56% from 2019 to 2028. And with the average cost running between $15,000 to $36,000, insurance coverage is an important consideration for the majority of patients. You can simplify the insurance process for your surgical patients by learning how to get insurance to pay for bariatric surgery.

    Read on to know which states require insurance plans to cover bariatric surgery and the typical insurance criteria for bariatric surgery coverage.

    Key Takeaways

    • Most insurance covers bariatric surgery. Coverage of bariatric surgery is a requirement for all individual, family, and small group insurance policies in 23 states.
    • The majority of insurers require a BMI of at least 40 for patients to qualify for bariatric surgery coverage.
    • Other typical criteria to demonstrate the medical necessity of bariatric surgery include past attempts at weight loss, passing a psychological evaluation, the cessation of smoking, and no evidence of substance abuse.

    What Can I Expect After Weight Loss Surgery

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    You will need to make significant lifestyle changes after bariatric surgery to lose weight and keep it off. For example, you will need to follow dietary guidelines, and youll probably take vitamins or other supplements for life. Your weight loss program will also involve increased physical activity.

    After the surgery, youll start with liquid foods. Over the next few weeks, youll change to pureed food, then solid food. Your meals will be much smaller and you may have to stop drinking with meals due to your small stomach.

    In some cases, people will initially lose weight but then their body becomes used to the changes made during the surgery and they can regain some of the weight.

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    How To Get The Most Out Of Your Insurance Coverage

    If your weight loss surgery is covered by insurance, there are a few things you can do to make sure you get the most out of your policy:

  • Be sure to review your eligibility criteria and coverage limits with your insurer.
  • Familiarize yourself with your insurers appeals process in case you need to contest a denial of coverage.
  • Make sure to keep all documentation related to your surgery, including receipts, medical records, and insurance correspondence. It will help you if you need to file a claim or appeal a decision.
  • What Will My Out Of Pocket Expenses Be

    Exact coverage for surgery will vary based on your benefits. We encourage patients to call BCBS Florida Blue directly using the phone number on the back of your insurance card or speak to your HR department for policies through your employer. During your office consultation, our Bariatric Coordinator will spend time with you to review your specific benefits and obligations, including what may be required for coverage.

    Many plans have deductibles, co-insurances and out of pocket maximums that reset with the calendar year each January 1st. If you are approaching the end of the year, your actual out of pocket expenses for surgery may be lower if you have already paid for medical treatment earlier in the year. Please keep in mind, there may be several required visits prior to surgery being scheduled and it is best to plan several months in advance, even if you plan to take advantage of a paid deductible or met out-of-pocket max for bariatric surgery.

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    Cash Options And Financing

    If you dont have insurance or have insurance with a high deductible plan, we have programs to help everyone achieve their weight loss goals. There is truly no better investment you can make than in your own health. Most studies show the cost of surgery is offset on average in two years just in savings in decreased medications, decreased hospitalizations, decreased doctor visits, etc. We accept cash, certified check, and major credit cards. American Healthcare Lending is an available bariatric surgery financing option when you seek assistance from our facility.

    Patients come to us from Greensboro, High Point, Kernersville, Winston-Salem, Burlington and neighboring communities. Schedule your online seminar to find out more about how our program can help you.

    What Is The Best Way To Pay For Bariatric Surgery

    Is Weight Loss Surgery Covered by Insurance??

    Before taking out health insurance, evaluating the costs, type of coverage, and additional benefits is essential. And if you already have insurance, analyze in detail the policy to know what it covers and what expenses it does not cover. In some cases, you may even appeal a denial of your request for bariatric surgery. Also, the laws of some states can be used in your favor as long as you have good medical backing.

    But what if your health insurance doesnt cover the cost of surgery? In that case, you must pay for it on your own. But all is not lost! There are two practical options:

    • Medical tourism

    If you live in a country where medical expenses are high, medical tourism offers you the option of traveling to another country where you can get high-quality medical service at a much more comfortable cost in your pocket. For example, there is currently a large influx from the US and Canada to undergo weight loss surgery in Mexico.

    Due to currency exchange, you can save up to 80% on expenses. For example, the gastric sleeve in Mexico can cost $8,450, while in the US, it costs $28,700, in Thailand $13,636, and in Costa Rica $10,500. Imagine it. You can start your bariatric treatment without the need to go into debt for a lifetime.

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