Insurance

Does Insurance cover weight loss surgery?

Obesity and its related illnesses cost employers millions of dollars in lost productivity each year.  To combat this issue, many employers are choosing insurance policies that cover Bariatric surgery and other weight loss services. However, since insurance plans vary, it’s important to start the process by requesting to have your specific policy examined for any type of coverage for weight loss procedures.

Our team of insurance specialists will speak directly to your insurance company to verify if you have benefits for these life-saving surgeries and get any requirements that will be needed to get you on your way to a healthier life.

The process from your first consultation to surgery can take from a few weeks to a few months, depending on the criteria in your specific policy.  This is one of the reasons that we suggestion having your benefits checked at the beginning of your plan term.  Many patients don’t realize the length of time the process can take and end up frustrated when they can’t take advantage of deductibles that have been met if they don’t get to surgery before the end of the contract year.  If you have benefits for weight loss surgery, we suggest that you come in quickly to find out any specific criteria that will need to be met before surgery.

 What insurance plans cover bariatric surgery?

Many health insurance plans cover bariatric surgery. However, health insurance plan coverage varies, so it’s important to examine the coverage provided by your plan.  This is a list of some of the plans that we work with

  • Aetna
  • Anthem Blue Cross Blue Shield
  • Blue Cross/Blue Shield
  • Cigna
  • Cofinity
  • Coventry
  • First Health
  • GEHA
  • Great West Healthcare
  • Group & Pension
  • Horizon Blue Cross
  • Humana
  • Mail Handlers
  • Multiplan
  • OptumHealth
  • PHCS
  • TMLT
  • UMR
  • Unicare
  • United Healthcare

If you don’t see your plan here, please contact us as terms change frequently.

What Bariatric Surgery Procedures are covered under insurance

  • Gastric Bypass
  • Gastric Sleeve
  • Lapband
  • Duodenal Switch
  • Conversion of Lapband
  • Conversion of Gastric Sleeve to bypass
  • Conversion of VBG to Bypass
  • Revision of Gastric Bypass

What are some of the common bariatric insurance coverage requirements?

  • Body mass index (BMI) greater than 40 or BMI greater than 35 with co-morbidities (diabetes, high blood pressure, etc.). To see if you meet these requirements, you can calculate your BMI using our calculator.
  • 18 years of age or older.
  • Diagnosis of morbid obesity.
  • A few insurance plans require participation in a physician-supervised weight loss program for extended time periods (this can vary from 3 to 12 consecutive months, depending on your insurance plan).
  • Psychological evaluation prior to surgery. Our bariatric clinic will either provide this service or refer you to a psychologist.
  • Documentation of failed diet and exercise plans.

Is pre-approval necessary?

Pre-approval is sometimes required for weight loss surgery. Our office will submit the required paperwork to your provider to make sure you are pre-approved.

What if my insurance provider denies the coverage for weight loss surgery?

You, as the patient and our office will both be notified if there is a denial of coverage and we will appeal the denial, if you choose to appeal.

*Actual weight loss results may vary based on the individual.


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