Does health insurance cover bariatric surgery? If you’re considering bariatric surgery, the cost is likely one of your biggest concerns. The good news? Many health insurance plans do offer coverage, but it depends on several factors.
Bariatric surgery is a major medical procedure that can significantly improve the health and quality of life for people struggling with obesity.
However, given its high cost, many wonder whether their insurance will help cover it. The answer depends on your provider, your specific plan, and whether you meet certain medical criteria.
Worried your policy might not cover it? Don’t stress; read on to find out when and how your insurance may help pay for bariatric surgery.
Does Health Insurance Cover Bariatric Surgery?
In many cases, health insurance does cover bariatric surgery, but not automatically. Most insurers require you to meet specific requirements before approving the procedure.
These may include a documented history of obesity, previous attempts at weight loss, and a recommendation from your doctor.
You might also need to undergo a psychological evaluation or complete a supervised weight loss program.
Coverage can vary widely depending on your provider and plan. Some plans cover only certain types of bariatric procedures, such as gastric bypass or sleeve gastrectomy, while others may exclude weight loss surgery altogether.
If you’re covered through Medicaid, Medicare, or an employer-sponsored plan, the guidelines may be different.
To find out if you’re eligible, it’s important to review your policy and speak with your insurance representative.
Your healthcare provider can also help by submitting the necessary documentation and explaining the medical need for the surgery.
When Does Health Insurance Cover Bariatric Surgery?
Most insurance companies will cover bariatric surgery if it’s medically necessary. That means your doctor must show that the surgery is essential for your health, not just a cosmetic choice. Common criteria include:
- A body mass index (BMI) of 40 or higher
- A BMI of 35 or higher with obesity-related conditions like diabetes or high blood pressure
- Documented history of failed weight loss attempts through diet, exercise, or medication
- A psychological evaluation to ensure you’re mentally prepared for the surgery and lifestyle changes
Some plans may also require you to complete a supervised weight loss program before surgery is approved.
Types of Bariatric Procedures Covered
Insurance plans usually cover common procedures such as:
- Gastric bypass surgery
- Gastric sleeve surgery (sleeve gastrectomy)
- Adjustable gastric banding (in some cases)
- Biliopancreatic diversion with duodenal switch (BPD/DS)
Each plan is different, so it’s important to check which procedures are included under your policy.
What Insurance Plans May Cover It?
There are difference types of health insurance plans that may cover Bariatric surgery and they include:
Private Insurance
Many employer-sponsored and individual health plans offer bariatric surgery coverage, especially those that follow the Affordable Care Act (ACA) guidelines. However, not all states require insurers to cover weight loss surgery, so it varies.
Medicaid
Most state Medicaid programs cover bariatric surgery for qualified individuals, but the requirements and approval process can be stricter.
Medicare
Medicare may cover certain types of bariatric surgery for patients who meet the necessary criteria, such as having a BMI of 35 or more and a related health condition.
How to Find Out If You’re Covered
Review Your Policy
Look for terms like “bariatric surgery,” “weight loss surgery,” or “obesity treatment” in your insurance plan documents.
Call Your Insurer
Speak with a representative to ask about specific requirements and coverage details.
Get Pre-Authorization
Most insurers require prior approval before you can proceed with the surgery. Your doctor or surgeon can help with submitting the necessary paperwork.
Ask About Out-of-Pocket Costs
Even if your surgery is covered, you may still be responsible for deductibles, copays, and other fees.
What If Your Insurance Doesn’t Cover It?
If your plan doesn’t cover bariatric surgery, you still have options. Some people:
- Switch to a plan during open enrollment that offers coverage
- Appeal the denial with help from their doctor
- Explore financing or payment plans through the surgical center
- Look into medical travel options for more affordable care abroad
Final Thoughts
Bariatric surgery can be a good step toward better health; but it comes with a high cost. Fortunately, many health insurance plans do provide coverage if certain conditions are met.
However, understanding your policy and working with your healthcare team, you can take control of the process and increase your chances of approval.
Therefore it is important to always check with your insurance provider and get clear on what’s required, so you can move forward with confidence.
