Will Insurance Cover Your Weight Loss Surgery? Let’s Find Out

Will Insurance Cover Your Weight Loss Surgery? Let’s Find Out

Excessive weight never helps a person be healthy. Most people with obesity or excessive weight often suffer various health conditions rob them of an active, healthy life. To achieve their health goals, they must opt for effective and reliable measures, like weight loss surgery.

This is why bariatric surgery in Tijuana, Mexico, and gastric bypass surgery in Tijuana and other parts of the world are so common. However, such surgeries require serious commitment and readiness, financially, emotionally, and physically.

Weight loss surgeries are typically quite costly; without insurance, many sadly find it an inaccessible option. It is common for people to grapple with questions such as:

  • Is bariatric surgery covered by insurance?
  • Is bariatric surgery covered by Medicaid?
  • Whether bariatric surgery is covered by insurance or not.

Hence, before you opt for it, it is best to learn how much insurance will cover the surgery or what weight loss surgery is covered by insurance to avoid financial roadblocks later.

What Weight Loss Surgery is Covered by Insurance?

Are you tired of trying to achieve your health goals through traditional practices, but find it not as fruitful? Then, a surgery might be the better option; but is weight loss surgery covered by insurance?

The fact is that every insurance company has a different coverage policy. Hence, other companies will offer different policies and plans for various procedures. Generally, though, we have seen only partial coverage by insurance companies in the case of bariatric surgeries.

These typically include the following:

  • Gastric band
  • Gastric sleeve
  • Gastric bypass

Insurance Coverage for Weight Loss Surgery – Common Requirements

As mentioned above, different insurance companies have various standard policies of coverage. Hence, their requirements, in the case of weight loss surgeries, also resultantly differ. While a medical policy or an employer can mandate the criteria, there are some common requirements for coverage.

These include:

  • Patients must not be substance abusers
  • Must opt for a weight loss program their particular insurance company mandates
  • Must produce documents of efforts to lose weight over some time
  • Must have a history of risk factors like Type 2 diabetes, high blood pressure with a 40+ BMI
  • Must be over 18 years of age (Certain insurance plans allow weight loss surgery coverage for those under 18)
  • Must produce a diagnosis report of morbid obesity preceding a certain period before the surgery
  • Must withdraw from smoking before the weight loss surgery
  • Must undergo psychological testing

Insurance Coverage for Your Surgery – Tips to Gain Approval

Learning about your insurance coverage and entitlements is best before deciding on medical assistance for your weight loss plans. Since the policies differ by company, yours may allow some coverage, making it easier for you to go ahead with the surgery.

In most cases, insurance plans cover a significant portion of bariatric surgery if patients meet the abovementioned criteria. Even if your insurance company’s criteria are different, it will be a very minute change from what most health insurance companies typically require.

Second, you will also have to provide the insurance company with a referral from your surgeon or primary care doctor. Along with your health history documents and previous weight loss efforts, you will most likely successfully gain some coverage approval from the company.

Suppose things do not proceed as favorably in your favor as you want them to. In that case, you can always prove to the insurance company why the surgery is a medical necessity. As mentioned above, excessive weight is often the cause of chronic or complicated health conditions, and patients may need necessary medical assistance to shed.

Alternate Options if Insurance doesn’t Provide Coverage

It is typical for insurance companies to provide only partial or no coverage at all for weight loss surgery. In such a case, accessing this option can become nearly impossible, considering the costly medical bills an individual has to incur.

However, people can consider specific alternate options if their insurance companies deny lending support for weight loss surgery. Let’s take a look at those below:

  • Centers like the Fitness Center and Duke Diet, among several others, offer specialized programs. If your insurance company fails to provide coverage for surgery, you may consider participating in a medically supervised and customized weight loss program at a reputable center.
  • If possible, the better alternative to insurance coverage is paying in cash for your weight loss surgery. You can consult a financial care counselor who will provide you with accurate estimates of what the procedure will cost. If your financial status allows you flexibility, you can always opt to pay in cash for the surgery. However, you must note that it is a standard rule to make payments in full before medical professionals conduct the procedure.
  • During enrollment, it is good to conduct extensive research to determine the options available. Hence, you can switch your insurance carrier if you find better policies and reputable companies. Extensive proactive research will help you shortlist the best coverage plans, especially about weight loss surgeries.

Final Thoughts

Weight loss surgery is often a medical necessity and the underlying cause of multiple chronic illnesses. Obesity and excessive weight can lead to various health conditions, such as diabetes, heart issues, cholesterol problems, high blood pressure, and more.

Often the traditional methods, such as diet, exercise, and detox plans, do not help reduce weight as effectively. Moreover, it takes very long for conventional methods to show a significant weight reduction; by then, the other health conditions may exacerbate.

In such cases, weight loss surgery is the only feasible and reliable option. However, this medical plan is costlier than the others, and insurance companies may or may not provide coverage.

About Me
Dr. Ramos Kelly MD, FACS - FASMBS

Dr. Ramos Kelly is a respected and highly experienced bariatric and metabolic surgeon who has been featured internationally.

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