Insurance Coverage of Weight Loss Surgery
One of the many questions people ask when they start looking into weight loss (bariatric) surgery is whether weight loss surgery is covered by insurance.
Though insurance can cover some or all costs of the procedures – there are some who will be forced to pay out of pocket.
I have Insurance Am I Covered?
Depends. Some coverage may be there, but it varies greatly by insurance provider and by state.
To find out out if you’re covered it requires that you call up your insurance company and see what, if any, procedure is covered. The most popular type of surgery covered is gastric bypass surgery.
A majority of insurance companies may pay up to 80% of the cost, leaving you to pay the rest. The companies consider this “customary and usual,” and is depended on the insurance company.
If your insurance company provides coverage, then your personal physician must inform the insurance company that bariatric surgery is medically necessary.
There must be solid evidence to back this claim up. Besides the relevant of information they must provide including BMI, age, weight, how obesity affects you, dieases or conditions caused by obesity – another is well-documented past failed dieting and exercise routines/programs.
Most physicians view bariatric surgery as the last resort to decrease the patients’ health risk(s).
Does Medicare Cover Bariatric Surgery?
Yes. Medicare recently announced that they would cover three types of procedures done in high-volume centers that achieve low mortality rates: Roux-en-Y Gastric Bypass, Open and Laparoscopic Biliopancreatic Diversions, and Laparoscopic Adjustable Gastric Banding.
In order to take advantage of medicare coverage, you are required to participate in 6 month medically supervised weight loss program.
You need have a body mass index over 35, and you need to have a health related problem – conditions that are the direct result of being obese (heart disease and diabetes).
Does Medicaid Cover Bariatric Surgery?
Depends on the state that you live in. Some states provide coverage.
Conclusion
Sometimes if your original claim for weight loss surgery coverage is denied, you can appeal.
Each insurance company has its policies and provisions.
If you are uninsured, or have been denied by insurance there are other options you may pursue, besides obtaining patient financing and paying for the procedure yourself.
One of the popular options is having low-cost bariatric surgery via medical tourism. Medical Tourism is when you traveling to a different country, with the most popular being Mexico and India, and having low cost surgery. This option can be thousands of dollars cheaper than paying yourself.
Another option is to obtain health insurance, a provider you know that provides bariatric coverage, then proceed to have the surgery. This option is far more riskier, and requires a lot of time.
Something the ideal candidate for weight loss surgery shouldn’t have.
