Is Bariatric Surgery Covered By Insurance?

Is Bariatric Surgery Covered By Insurance?

If you are considering weight loss surgery, you may be concerned about the cost. However, nowadays, many insurance companies offer coverage for bariatric procedures.

Should You Submit Information to Your Insurance Company for Pre-Approval?

If you have health insurance, you may be surprised to find that your insurer may cover the cost of your bariatric surgery. Many insurance companies cover the most common weight loss procedures, such as gastric bypasses, gastric sleeve procedures, gastric banding and revisions. Your physician can submit the information needed for pre-approval on your behalf.

Can an Insurance Company That Often Denies Weight Loss Procedures Still Approve Your Request?

Some insurance companies offer different levels of coverage based on the details of your particular policy. As a result, even if another bariatric surgery patient has the same insurance carrier, he or she may not have the same coverage level that you enjoy. Thus, your insurer will approve or deny your coverage based on the details of your policy. You may be able to check your policy beforehand to confirm whether or not weight loss surgery is covered. However, for the quickest response, you can call your insurance company directly at the number listed on your insurance card.

Is There Anything That You Need to Do to Help Increase Your Chances of Approval for Your Bariatric Surgery?

You do play a role in the approval process for your bariatric procedure. Although your physician will contact your insurance company on your behalf to begin the approval process, it is important for you to attend all of your scheduled appointments and follow the advice of your surgeon. Your final approval will often be dependent on well-documented records that detail your condition and your compliance with your doctors. You may be required to lose a certain amount of weight before your bariatric surgery is approved.

Additionally, your physician may be required to submit records indicating your failure to lose weight after repeated attempts at less invasive recommendations, such as dieting and exercise. He or she may also need to provide proof that your obesity is not caused by another systemic condition that will not be improved by the surgery. Also, the doctor will present your exact weight and height to confirm your BMI.

Bariatric surgery is usually only approved for the following:

  • Morbidly Obesity: People who are morbidly obese have a BMI of 40 or more.
  • Obesity with a Concurrent Weight-related Condition: If you are obese with a BMI of 35 or more and you have been diagnosed with a condition, such as a type 2 diabetes or hypertension that is directly related to your excess weight, your bariatric surgery may be considered medically necessary.
  • Adults: Because the body of an obese child is still developing, weight loss surgery is usually not approved for people who are under the age of 18.
nurse listening to patient

How Do You Know the Specific Coverage Requirements of Your Insurance Policy?

Your insurer may require specific tests and documentation before your bariatric surgery can be approved. For instance, the insurance provider may request that you see specialists approved to treat bariatric conditions before approving the surgery. These specialists may include a cardiologist to ensure that your heart is healthy enough for the surgery and a psychotherapist to help determine whether or not you have the willpower necessary to make long-term changes.