Weight loss surgeries are highly beneficial and provide a solution for those who struggle with obesity. People with underlying issues like Type 2 Diabetes and sleep apnea might also benefit from weight loss surgery.
Generally, health insurance companies consider weight loss surgery a medical necessity for those who are significantly overweight and have tried unsuccessfully to lose weight through traditional methods such as diet and exercise. We will explain how much insurance covers weight loss surgeries, which procedures are covered, and the criteria that must be met for your coverage to be approved.
Which Types of Weight Loss Surgery Are Covered by Insurance?
Most health insurance companies cover Procedures like gastric bypass, adjustable gastric banding (lap band), sleeve gastrectomy, biliopancreatic diversion, and duodenal switch. However, the extent of coverage depends on the specific policy you have.
It is important to note that each insurance carrier has criteria for determining coverage. These may include:
1) The Type of Weight Loss Procedure
When researching the types of weight loss surgery that may be covered by insurance, it is essential to understand the process for coverage approval. Each insurance carrier has different criteria for approving a patient for specific procedures. Some carriers may not cover certain types of surgery, such as gastric bypass or sleeve gastrectomy.
2) Body Mass Index (BMI)
Insurance carriers typically require a patient to have a BMI greater than 40 or, in some cases, 35. A BMI of 40+ is considered morbidly obese and can lead to significant health complications, including type 2 diabetes, hypertension, heart disease, stroke, sleep apnea, and joint pain.
3) Medical Necessity
Insurance carriers may require evidence of medical necessity before approval. This means an individual must demonstrate the need for a weight loss procedure due to related complications, such as diabetes or sleep apnea. Additionally, some carriers may require a period of diet and exercise before approval.
It is essential to provide documentation such as lab results and doctor’s notes to prove medical necessity. This can include body measurements, BMI calculations, physician assessments, or other forms of evidence.
5) Co-Payments and Deductibles
It is important to note that while insurance policies may cover some or all of the cost of a weight loss procedure, many require a co-payment or deductible. It is essential to read the fine print of your policy to determine if this is part of your coverage.
Medicare and Medicaid are the two largest health insurance programs offering weight loss surgery coverage. If you meet specific criteria, Medicare will cover bariatric surgeries, such as gastric bypass, sleeve gastrectomy, and adjustable gastric banding. Medicaid is a state-funded program, so coverage and eligibility may vary from state to state.
All health insurance providers may not cover bariatric surgery is a significant investment. Call Arch Bariatrics for bariatric surgery in St. Louis. We accept most major insurance plans, and our team can investigate your coverage options with you. Our team can also help you find financial assistance when coverage is not available or limited. You can prepare for your consultation by gathering information from your insurance provider about any weight loss surgery coverage they may offer.