Bariatric surgery is a type of weight loss surgery that helps obese people to lose weight and improve their overall health. It has become increasingly popular in recent years as an effective approach for people struggling with obesity. However, the cost of this procedure can be prohibitively expensive for many patients, leading them to ask: does insurance cover bariatric surgery?
The answer is not universal; it depends on the specifics of the patient’s individual insurance plan and the provider. In most cases, if a patient meets certain qualifications, they may be able to get at least part of their bariatric surgery costs covered by their insurance company. We will discuss what those qualifications are and how you can determine if your insurance will cover bariatric surgery.
Qualifications for Insurance Coverage of Bariatric Surgery
Most insurance companies will consider covering the cost of bariatric surgery, but it is essential to be aware of the eligibility criteria that must be met first. Therefore, to understand if insurance will cover bariatric surgery, it is important to first understand what qualifications must be met for a patient to be eligible.
It is best to consult with both your doctor and insurance provider to determine whether you may be eligible for coverage under your existing policy. However, generally speaking, most insurance plans will only consider covering the cost of a bariatric procedure if the patient meets certain criteria including:
- The patient must have an official diagnosis of obesity; this usually requires having a body mass index (BMI) of 40 or more, or 35 or more if they have one or more other health conditions such as diabetes or heart disease that could be helped by losing weight. It’s important to note that insurance policies vary; thus, meeting the mentioned criteria does not guarantee eligibility, but it is an important first step in determining whether or not bariatric surgery may be covered under your health plan.
- The other requirement is that the patient must have demonstrated an attempt (and failure) at other methods of weight loss, such as diet and exercise. Being able to document a history of unsuccessful attempts provides evidence that bariatric surgery is the best course of action given the patient’s obesity-related condition and health goals.
- Another important criterion stipulates that the patient must have regular physician visits and consultations with a doctor or an appropriate healthcare professional, who should then officially recommend bariatric surgery after careful consideration. The recommender must also often conclude that there are no better options than bariatric surgery in helping the patient achieve health goals, such as weight loss or improvements in underlying medical conditions, and that the patient meets all required criteria for the surgery. Therefore, it is essential for those interested in receiving insurance coverage to secure a documented recommendation from their doctor as evidence of medical necessity before they can apply for insurance approval.
- Finally, the patient must be willing to commit to long-term lifestyle changes that can maintain their weight loss achieved through the procedure. This includes following healthier eating habits and incorporating regular physical activity into their day-to-day lives after the surgery is completed. Making these adjustments can help ensure that patients get the most out of their bariatric surgery treatment and support them in sustained weight management success.
It is important for anyone considering bariatric surgery to thoroughly research the qualifications for insurance coverage to ensure that the surgery is a viable option for them.
These are generally the most common qualifications that must be met for insurance companies to consider covering the cost of bariatric surgery. In addition, it is essential to remember that some insurance plans may require additional qualifications or prerequisites that patients need to meet for bariatric surgery coverage to apply beyond what has been mentioned here.
As such, it is important to speak directly with your provider to understand the exact standards required for coverage consideration, and that all relevant criteria are determined before following through with any decisions regarding bariatric surgery.
How To Determine If Your Insurance Will Cover Bariatric Surgery
Once you have determined that you meet the qualifications for insurance coverage of bariatric surgery, the next step is to determine if your particular insurance plan will cover it.
The best way to do this is to contact your insurer directly and ask about their policy on bariatric surgery coverage. When calling or speaking with a representative from your insurer, it is important to provide as much information as possible about your situation so that they can accurately assess whether or not you qualify.
This includes providing details such as your BMI, any existing health conditions, any weight loss methods you may have attempted in the past, and most importantly, a doctor’s recommendation for bariatric surgery.
If Your Insurance Does Cover Bariatric Surgery – What to Expect
If your insurance does cover bariatric surgery, then the next step is to get all of the paperwork in order and begin prepping for the procedure.
Generally speaking, most insurance companies will require that you meet with a pre-authorization specialist or case manager before they will approve coverage. This person will review your medical records and determine if you are eligible for coverage based on their criteria.
Once approved for coverage, it is important to keep in mind that there may still be some out-of-pocket costs associated with the procedure as well as any follow-up visits or tests necessary afterward. Additionally, it’s important to note that while many insurers do cover bariatric surgery, they usually have certain restrictions surrounding when and where the procedure can be performed.
Bariatric surgery can be an effective way to combat obesity and long-term weight management, but, if you are considering bariatric surgery and have health insurance, it is important to first determine if you meet the qualifications for coverage and then contact your insurer directly to get all of the necessary information about their policy on bariatric surgery.
By understanding the qualifications necessary for coverage and speaking with a representative from your insurer, you can determine if bariatric surgery is an option for you. Armed with this knowledge, you can then begin prepping for the procedure and start on your journey toward a healthier life.