Weight Loss Surgery Insurance: Does Insurance Cover Gastric Sleeve?

Obesity in the US, Canada, and some other countries has increased in epidemic proportions over the last two decades. Fortunately, most large health insurance providers now recognize obesity as an illness and offer weight loss surgery insurance coverage. As long as you meet the eligibility criteria of your insurance provider and have adequate coverage under your health plan, you may have your weight loss surgery covered by insurance.

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Does insurance cover weight loss surgery?

Yes, insurance covers weight loss surgery, subject to certain conditions. Each insurance company has its own set of pre-requisites, which must be fulfilled before you are approved for bariatric surgery insurance payment. Even within the same insurance company, different medical plans are available, so you should be aware of the policy terms of your individual health insurance that covers bariatric surgery.

Procedures: Major weight loss procedures covered by insurance include gastric sleeve surgery, Roux-en-y gastric bypass, standard gastric bypass, adjustable gastric band (lap band), and biliopancreatic diversion with duodenal switch. Revision bariatric surgery insurance coverage may be available if the primary surgery was covered.
Non-covered: When a bariatric procedure is performed solely for cosmetic benefits, weight loss surgery insurance coverage is not available. Treatments for obesity induced by medications, hormonal balances, psychiatric, or eating disorders may also not be covered. Experimental or new procedures such as mini gastric bypass are not covered.
Waiting period: Patients often ask does insurance cover weight loss surgery. The answer is yes, but it does not mean that you can buy insurance to cover bariatric surgery just before your procedure. The insurance company will impose a waiting period ranging from two to four years from the date of purchase of your health plan.

CHECK THIS: How to get weight loss surgery approved?

Best health insurance for weight loss 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 (PPO) and Health Maintenance Organization (HMO) 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?

Can I buy insurance to cover bariatric surgery?

Yes, you can buy insurance to cover bariatric surgery. A variety of weight loss surgery insurance options are available today. Before you make a buying decision, you should evaluate the salient features, benefits, and limitations of each type of bariatric surgery insurance option that you may be eligible for.

Options for buying insurance to cover bariatric surgery

Private individual health insurance that covers bariatric surgery
Group health plan from your employer or your spouse’s employer
Continuing health coverage from former employer under COBRA
Health plan of your parents (if you are up to 25 years old)
US government healthcare plans, such as Medicaid and Medicare
State medical insurance program, if available through your state
Tricare for military service personnel or VHA plans for veterans

Questions to ask when buying bariatric surgery insurance

Can I choose any hospital or doctor for my weight loss surgery?
How much will be deductibles I should pay every year?
Does the weight loss surgery insurance include co-pays?
Does the health plan cover the cost of prescription drugs?
What documents are required to qualify for bariatric coverage?
How much is the waiting period before by coverage begins?
What is the dispute resolution process, if my claim is denied?

READ THIS TOO: Financing weight loss surgery in Mexico

Gastric sleeve insurance

Gastric sleeve surgery is now widely recognized as one of the safest and most effective procedures for weight loss. As a result, gastric sleeve insurance coverage is easily available through most of the leading health insurance providers. A large part of your costs associated with your surgery can be covered through a competitive weight loss insurance policy.

Top companies offering gastric sleeve insurance

Leading health insurance providers, such as Anthem Blue Cross Blue Shield, Aetna, Emblem, Cigna, HealthNet, United Health Care, and Priority Health provide gastric sleeve insurance coverage subject to conditions. Insurers recognize that gastric sleeve surgery will help reduce a patient’s lifetime healthcare costs, so the insurance company will indirectly benefit.

How to qualify for gastric sleeve insurance coverage?

To strengthen your chances of having your VSG weight loss surgery covered by insurance, you should request your bariatric surgeon to provide you a letter confirming that this procedure is a ‘medical necessity’ for you. In addition, it will help if you can provide proof showing that you have already undergone a medically supervised non-surgical weight loss program.

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Gastric bypass insurance

Gastric bypass surgery is one of the top weight loss surgery procedures covered by insurance. A research study has shown that gastric bypass insurance coverage was utilized by the largest number of Medicare beneficiaries among various bariatric treatment options. For your gastric bypass insurance, you also have the option to choose individual health insurance covers bariatric surgery.

Pre-requisites for gastric bypass insurance coverage

You may be eligible for both open and laparoscopic Roux-en-y gastric bypass insurance if your BMI is 40 or above, or between 35 and 40, along with at least one obesity-related medical condition such as Type 2 diabetes. Medicare as well as some private insurers may also require you to show proof of an unsuccessful attempt to achieve weight loss non-invasively.

Costs and services covered under gastric bypass insurance

Your weight loss surgery insurance for gastric bypass may cover costs related to the diagnosis, surgical procedure, and post-op recovery. Covered services may include surgical services performed in the operating room, hospital stay, pre- and post-op medical exams and lab tests, prescription medications, and check-ups with your bariatric surgeon and other doctors.

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Revision bariatric surgery insurance coverage

Revision bariatric surgery insurance coverage may be available subject to certain conditions. Your insurer will check whether the primary procedure was performed using weight loss surgery insurance coverage. If the primary surgery was performed for cosmetic reasons and without insurance coverage, you may not qualify for a revision procedure either. Here are a few things to remember for obtaining revision bariatric surgery insurance coverage.

Even if you have the best health insurance for weight loss surgery, your insurer will ask many questions before they approve a revision.
Most insurance companies will want to determine the causes of your weight loss failure or complications that warrant a revision surgery.
If the insurer finds that patient non-compliance has led to a request for revision bariatric surgery insurance coverage, they may reject it.
If your revision surgery plan involves a new type of procedure, check in advance whether your insurance company covers this procedure.
To obtain revision bariatric surgery insurance coverage, it is best to back your request with medical test reports and proof of compliance.

Weight loss surgery insurance secrets

When you have made the big decision to achieve permanent freedom from obesity, nothing should come in your way to qualify for weight loss surgery insurance. However, in reality, many patients experience challenges in getting approvals or face claim denials from their insurers. Here are five proven weight loss surgery insurance secrets that will help you obtain approval for maximum coverage from your insurance company.

Secret 1: Even if you fulfill the BMI criteria and other pre-requisites to qualify for bariatric surgery insurance, do not take the approval for granted. Obtain a ‘letter of medical necessity’ from your surgeon for the insurer.
Secret 2: Maintain a meticulous record or a journal as well as photographs of your diet and exercise efforts that did not work for you. Ideally, join a medically supervision non-surgical weight loss program before surgery.
Secret 3: If you want to choose a bariatric surgeon who is not a part of your insurance network, request your insurer ahead of time to have the surgeon included in the network. This will boost your chances of getting approval.
Secret 4: One of the weight loss insurance secrets for those with group insurance through employer is to request the HR manager to add bariatric surgery as a covered procedure. Large companies can easily do this with insurers.
Secret 5: If your health plan deductibles, co-pays and other out-of-pocket costs are high, check if the insurer will reduce your costs if you choose low cost medical tourism. This is one of the key weight loss insurance secrets.

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The bottom line

Bariatric surgery is an expensive procedure. The goal of weight loss surgery insurance is to make this procedure accessible and affordable to anyone who needs it. However, the insurance approval can be cumbersome and many patients are left out of the process. If you are in this situation, talk to a dedicated bariatric surgeon today for safe and affordable self-pay options.