Alleviating the conditions of morbid obesity may require more than regular exercise and a balanced diet. In such times, bariatric surgery can be your best bet.
However, for obese patients who qualify for a weight loss surgery, one of the biggest concerns is – “does insurance cover my bariatric procedure?”
Bariatric surgery is a costly weight loss procedure. The average cost may range between $15,000 and $35,000 across all types of bariatric surgeries in the U.S. The costs are substantially higher even in Canada, Australia, and New Zealand. For any average-income person, paying for the procedure out of their pocket can be considerable. As such, health insurance seems to be a viable option to fund one’s bariatric procedures.
Earlier, most insurance companies did not cover weight loss surgery in their health plans. But with the growing prevalence of bariatric surgery in recent times and even the federal government approving the procedures, many carriers have started to include weight loss surgery in their coverage plans.
When considering getting a bariatric procedure done, insurance is the ideal way to go. However, whether you should pay out of pocket or through insurance will depend on the type of policy you have. Today, most major insurance carriers cover laparoscopic gastric bypass, gastric sleeves, and lap band surgeries. However, that does not mean your health plan also provides coverage for such procedures.
While some plans entirely exclude bariatric surgery, others may require you to pay more to include coverage for weight loss procedures, Read your individual health policy carefully or ask your agent to know what’s covered and what’s not.
If you are lucky to have an insurance plan that covers bariatric procedures, then it is likely you’d want to know what’s covered in the policy. This may vary depending on your policy type, insurance company, or how much you pay for the coverage. Typically, a health plan will protect your finances by providing a wide range of benefits that include:
However, there are certain eligibility criteria that you must fulfill to get coverage for your bariatric surgery. Most insurance companies need the individuals to meet the following conditions:
Today, many insurance carriers provide health plans covering various types of bariatric procedures. In this article, we will discuss the popular ones based on some important criteria. Let’s get started.
Aetna is a leading insurance provider that covers most bariatric surgeries, except Aetna QPOS and HMO plans that exclude all obesity-related surgical procedures unless otherwise approved by the carrier. To qualify for insurance coverage, patients must meet the following criteria:
Bariatric procedures that are covered by Aetna include:
Roux-en-Y gastric bypass surgery, performed for the treatment of gastroesophageal reflux in non-obese patients, is not covered under Aetna health plans. They further do not mention that the surgery must be performed at an institution accredited by the Center of Excellence.
Most Anthem Blue Cross Blue Shield policies across the entire network cover bariatric surgery unless and otherwise clearly excluded from the plan. However, your employer might opt-out from including bariatric surgery in employee policies, saving more money for the company on premiums. Therefore, make sure you seek information from the insurance company or contact an agent to learn whether your plan covers bariatric procedures. To get BCBS insurance approval for bariatric surgery, here are some minimum requirements you must meet:
Various types of bariatric procedures are covered under Athena BCBS plans. These are:
Anthem BCBS excludes Banded Vertical Gastroplasty, Mini-Gastric Bypass or other bariatric procedures that are still in the experimental stage. A second bariatric procedure or revisions are also included in the plan if specific criteria are met as mentioned in the policy.
Cigna is another widely popular insurance company that covers weight loss surgery in most types of policies. However, there are ones that entirely exclude bariatric procedures. So, make sure you read your policy carefully or talk to a Cigna insurance agent before buying one. The prerequisites to get approval for insurance coverage include:
Weight loss surgeries that Cigna covers in their policies are:
One of the basic concerns of an obese patient is – does Cigna also cover lap band fills? Yes, they do cover lap band fills because the insurance company considers it an important weight loss procedure. However, some procedures that are not covered are intragastric balloons, gastric bypass surgery that is combined with a gastric band, loop gastric bypass, Fobi-pouch, or other experimental procedures. Cigna also covers a second bariatric surgery if you can provide evidence that the first procedure has failed to help you lose 50% of excess body weight.
The national health insurance program also covers some bariatric procedures, given you meet the below-mentioned requirements:
Currently, Medicare does not require the surgery to be performed in a facility approved by the Center of Excellence.
When it comes to getting insurance coverage for your weight loss surgery, United Healthcare might not be a viable option because their Summary Plan Descriptions and Certificates of Coverage outrightly exclude coverage for bariatric procedures. But several plans do cover weight loss surgery. As a matter of fact, certain states make it mandatory for insurance carriers to cover such procedures. Therefore, even if your United Healthcare plan does not cover weight loss surgery, you can still have good luck if your state mandates such coverage.
To get approved for the coverage, you need to meet the following requirements:
Despite United Healthcare isn’t the best choice to have insurance coverage for your bariatric surgery. But there are several procedures included in their plans that accept weight loss surgery:
For adolescents, the following bariatric procedures are covered:
If your lap band procedure does not work the first time or a complication arises that requires your further treatment and hospitalization, United Healthcare will also cover the same provided you qualify the criteria.
There are several options if insurance denies your bariatric surgery claim:
In addition, you may want to consider low-cost self-pay bariatric surgery in Mexico. With low-cost bariatric surgery, you can bypass a lot of the headache of going through insurance and get the surgery on your schedule. You an in addition lower your out-of-pocket expenses by paying directly to a provider in Mexico.
If you are considering undergoing bariatric surgery, funding it through your insurance plan might be the best option. However, not all health plans cover weight loss surgery. So, it is important to read your insurance policy thoroughly and check what’s included. If weight loss procedures are not covered in your plan, talk to an agent to get it included right away.
If you have an insurance policy from any of the carriers discussed above, the article can be helpful to talk to your agent and discuss what you can get included in the existing plan. For an additional cost, you can upgrade your policy to include weight loss surgery or buy a new plan. According to industry experts, even if your plan does not cover bariatric surgery, you may be lucky to get coverage if the insurance carrier considers the bariatric procedure a medical necessity for your obesity condition.
But before you get an insurance plan, read and understand what all will it cover. It is better to have comprehensive coverage for the weight loss surgery because it is a costly procedure and you may also require post-operative consultation or treatment.