Insurance costs money.

Weight Loss Surgery Insurance Coverage And Costs

In Insurance and Costs, Pre-approval Process by OC Staff

One study shows that the average time from the point someone considers weight loss surgery to actually having the procedure is 3 years. A lot of time can be spent studying, reading and talking to post-op patients about their surgery. The average cost of gastric bypass surgery is $23,000, the average cost of lap band is $14,500, and the average cost of sleeve gastrectomy surgery is $14,900. So before getting too involved, spend time determining if your insurance will cover weight loss surgery.

Weight loss surgery is predominantly performed on middle to upper class patients. Most people considering weight loss surgery cannot pay $20,000 to lose weight. But today, more than ever, insurance companies are starting to cover weight loss surgery.

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 doesn’t 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 what’s included and what’s 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 (the number is usually on the back of your insurance card).

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.

Your covered!

If you have coverage, then it’s 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 don’t have coverage.

You still have options. Remember it took you a long time to gain the weight and you’ve probably been trying for most of your life to lose the weight. Be patient and stay focused on getting to surgery.

  • Before it’s time to choose your benefits for the year, make a call to HR and ask specifically about weight loss surgery. Often, the PPO plan offered includes weight loss surgery coverage while the HMO plan does not. And if none of the insurance plans offer weight loss surgery, ask why. There is great evidence available that shows the health benefits of weight loss surgery. Not only will having the surgery, change your life, it will make you a more productive worker!
  • Consider a medical loan. Many bariatric programs work with companies that offer loans for patients who want to undergo bariatric surgery but do not have insurance coverage. Ask your bariatric surgeon if they work with any financial institutions for loans.
    • Your car probably cost more than bariatric surgery. Which one will make you healthier and feel better?
  • Consider a job with amazing benefits. Yes, in some cases it may make sense to look for a new job just for the benefits.
  • Medicaid typically covers weight loss surgery. Do you qualify for Medicaid? Does it make sense for you to switch to one of those insurances just for the weight loss surgery coverage?
    • Double check to ensure your state Medicaid program covers weight loss surgery before switching.

Certain states have laws that require insurance companies to cover weight loss surgery if the patient meets the NIH health criteria. And not all insurance companies will cover an entire procedure. Some will cover the procedure but not the anesthesia or an overnight hospital stay. While other insurance companies do not cover any form of weight loss surgery.

Did you Know ?

Most insurance companies have some sort of coverage for weight loss surgery. Again, the key is to check if your policy includes coverage.

What else should I know?

How much does weight loss surgery cost if I pay cash?

How Do I Get Approved For Bariatric Surgery?

Dealing with insurance approval and rejection and appeals and denials creates a roller-coaster of emotion. Let the experts do their part. Your surgeon should have an in-house expert that will contact your insurance and start the process for approval.

Do not assume that your job is finished after you’ve been approved!

Make sure you are staying on top of your duties and appointments. There will be many. Keep documented records of everything and check in with the specialist regularly.

This is also a great time to change bad habits. You’re on your way to getting a life-changing procedure. Start changing your eating and exercising habits now or the change after surgery will be harder to make. Remember, surgery does not guarantee success. In fact, if you don’t change your habits, even though you’ve had weight loss surgery you will fail. And surgery is actually easier for the surgeon if you’ve lost some weight before surgery. This decreases the size of your liver which makes it easier during the operation and it decreases your risk of complications due to anesthesia.

Where Do I Find Coverage Requirements For My Policy?

Each insurance provider will require different documents and different tests. They may also require that you visit approved specialists. These can range from an approved psychotherapist to an approved cardiologist.

The best thing to do is to call your insurance company or your HR department if your insurance is supplied through work. We have our own list that you can check as well.

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