Does Your Insurance Cover Weight Loss Surgery?

Choosing to have weight loss surgery, whether it’s gastric sleeve surgery, gastric bypass, or another weight loss surgery option, can be stressful, even with all the helpful information out there. One of the biggest concerns you might have about surgical weight loss may not even be about the surgery itself, but another factor—insurance.

Just as there are different types of weight loss surgery, there are different types of health and medical insurance. You may be wondering how to finance the surgery or if your insurance will cover a portion, or all, of the bill.

macbook pro stethoscope iphone and sunglasses on desk

What Will Surgical Weight Loss Cost?

Depending on your type of weight loss surgery, the total cost can vary significantly. so you’ll want to know for sure what you’ll be responsible for covering. Unfortunately, many insurance companies don’t want to cover even minimally invasive weight loss surgery, though they do cover the costs associated with obesity—medications, hospitalizations, and doctor visits.

Before we get too mad at your insurance company, it’s important to note that, in many cases, whether you are covered or not has to do with your employer and the benefits they offer you. If your plan does have the coverage, your next hurdle may be qualifying for the surgery. Insurance companies will be looking for complete records and documentation—and you may have to send it several times before they accept it. Don’t give up, though! They will be counting on the hassle discouraging you.

How Do I Find Out if I’m Covered for Surgical Weight Loss?

● Best option: Have your doctor or surgeon’s office contact your insurance company directly. They have the knowledge and experience to ask the right questions, as well as the correct medical codes the insurance company might ask for. They will also know what the approval process looks like and how to proceed.

● If you’d rather do it yourself: Call your insurance company. Be sure you have the medical codes for the different types of weight loss surgery you are talking with your surgeon about and try to research your plan beforehand.

● If your Job has an HR department, they should be able to help you access your benefits and contact the insurance company on your behalf, if you prefer.

doctor holding a stethoscop

How to Get Approved for Bariatric Surgery Coverage

Getting approved to have your bariatric surgery covered can seem complicated, but it’s just a few steps. Don’t forget, though, that this can take some time—even up to a year.

1. Prove to your insurance company that you need the surgery:

a. Meet the BMI (Body Mass Index) weight requirements laid out by your insurance plan.
b. Go through a medical diet program that your doctor or surgeon approves and will oversee (this will take several months, so be prepared for it).

2. Meet with your team:

a. Make an appointment with your bariatric surgeon.
b. Make an appointment with your regular doctor and have them give you a medical clearance letter.
c. Meet with a psychiatrist and have them give you a mental health clearance letter.
d. Meet with a registered nutritionist for an evaluation.

3. Send all the paperwork:

a. Medical clearance and mental health clearance letters.
b. Proof of BMI and medical diet program.
c. Health history, past programs and diets, and anything else to show you’ve tried to lose weight before seeking weight loss surgery.

4. Wait for the review process:

a. If you’re approved, great! You can move forward with scheduling your bariatric surgery with your surgical team.
b. If you’re denied, don’t fret! You can always appeal their decision. Be sure to get details as to why you were denied and talk to your HR department and doctor’s office to get what you need to re-submit.

If you’re still in the early stages of researching the different types of weight loss surgery or have questions about your options, reach out to the experts at the Houston Sleeve Surgery Clinic. Their compassionate and experienced staff can help determine what you need to move forward with your weight loss journey. Give them a call today at (281) 888-7767 or look through their website.

Disclaimer: This is only for general information. All patients should consult their doctors prior to following any of the recommendations in any articles, posts, or videos. All patients have individual needs and limitations that only their treating physicians can be aware of.

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