What Weight Loss Surgery is Covered by Insurance?

Weight Loss Surgery is Covered by Insurance

If you’re considering weight loss surgery, you’ve likely done preliminary research about the benefits, risks, and cost. Given that weight loss procedures can cost upward of $20,000 out of pocket, sticker shock may bring your weight loss journey to a halt. However, many insurance providers now offer coverage for bariatric surgery. In fact, most insurance companies that cover weight loss surgery will cover gastric bands, laparoscopic gastric bypass, and gastric sleeve surgery.

Policy Matters

Although many insurance carriers offer coverage for bariatric surgery, not every policy includes this benefit. Some policies may only provide partial coverage, while others may outright exclude bariatric procedures. You can call your insurance provider to see how much coverage they offer to help guide your next steps.

If you’re covered, you can continue your weight loss surgery journey. Consider attending seminars to meet with others who had bariatric surgery to learn more about their experiences. If you don’t have coverage, you have a few options to explore:

  • Get in touch with HR. Insurance providers have an annual open enrollment that allows you to make changes to your coverage. While some policies that provide coverage for bariatric surgery are more expensive than those that don’t, it’s a fraction of the cost of the procedure itself. HR will be able to tell you which policies provide coverage for bariatric procedures. If none of the policies offer coverage, inquire as to why. A plethora of evidence demonstrates the benefits of weight loss surgery and why employers should include policies that cover it.
  • Look into your state’s laws. Some states stipulate that insurance companies must cover weight loss procedures if the individual meets the NIH criteria for bariatric surgery. However, it’s important to research how much coverage you will receive. Some insurance carriers only cover the procedure itself, which leaves you responsible for the anesthesia and hospital stay. Even so, this is significantly less expensive than paying 100% out of pocket.
  • Consider a medical loan. This type of loan often has 0% interest, meaning you won’t pay more than what the procedure costs. Some bariatric surgeons offer the procedure at a discounted rate when insurance doesn’t cover any of it. Your surgeon may also be able to recommend financial institutions that offer medical loans.

The Approval Process

Once your insurance provider approves the procedure, your work isn’t done. Many insurance carriers require you to meet with your doctor several times, undergo various tests, and keep detailed records. Contact your insurance provider or HR department to find out exactly what you need to do.

You should make changes to your diet and exercise habits as well. Weight loss surgery does not guarantee you will lose weight. While it is a tremendous help, your habits will play a much larger role in your weight loss success. For instance, if you are an emotional eater, this isn’t likely to change after surgery. Trying to change this behavior after surgery is much harder with your reduced stomach size.

Meeting with a nutritionist can help you develop a healthy diet. Psychotherapists can help you if you struggle with using food as an emotional crutch or if you’re worried you have a food addiction. Taking steps to improve your diet and exercise habits now can also help you lose a bit of weight prior to the surgery. This helps to reduce your liver size, which makes it easier for your surgeon to perform the operation.

Finding out which bariatric procedures your insurance carrier covers may require you to jump through some hoops, but it’s well worth the effort. Bariatric surgery can help improve obesity-related illnesses such as high blood pressure, heart disease, fatty liver disease, asthma, sleep apnea, and more.

 

T0 learn more about the benefits of bariatric surgery, contact Dr. Waldrep.

 

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