Is Weight Loss Surgery Covered by Insurance?

Many people have tried everything under the sun when it comes to losing weight. Diet and exercise are always the first steps in your weight loss journey. However, sometimes the assistance of weight loss surgery is the answer.

So, is weight loss surgery covered by insurance? Here’s everything you need to know. 

Why Would You Get Weight Loss Surgery?

Multiple health issues come from obesity. These include: 

• Heart disease 
• Stroke 
• High blood pressure 
• Diabetes 
• Severe sleep apnea

Getting weight loss surgery will allow you to lose weight and give you the tools to keep it off. 

Weight Loss Surgery Options

There are several weight loss surgery options that you can choose from. Some of these include: 

• Laparoscopic Duodenal Switch
• Gastric Sleeve 
• Gastric Band 
• Gastric Bypass  

The Cost of Weight Loss Surgery 

Weight loss surgery is a big financial and emotional decision to come to. But when this is necessary for health reasons, it is worth looking into all financial possibilities to reach your goal. 

The benefits of the surgery are great, but the cost of the surgery can be overwhelming to prospective patients. According to the American Society for Metabolic and Bariatric Surgery, the cost of weight loss surgery ranges between $17,000 and $26,000. This is the general cost without any insurance coverage.

Does Insurance Cover Weight Loss Surgery? 

The simple answer to this question is that it depends on your insurance and your history. The good news is that most states have been working towards health insurance coverage for weight loss surgery. Look closely at your insurance policy, and work with your doctor and insurer to find out what’s covered.

An insurance company might only cover weight loss surgery on their higher covers. They may also cover a certain percentage of the weight loss surgery. This means that you will still need to pay out of pocket for a large part of the surgery. 

There are a lot of things to consider when you ask your insurance company to pay for this type of surgery.

This includes: 

• Your History 
• The criteria for the desired surgery
• Exemptions 

Your History 

The first thing that any doctor and insurance company would investigate is your health history. If your weight is impacting your health already, or could in the future, it adds motivation to cover the surgery. 

The Criteria for Desired Surgery 

Your insurance company may ask for the following criteria: 

• A letter of recommendation from your doctor
• Proof that surgery is necessary
• Required participation in a physician-supervised diet plan to change habits
• A psychological evaluation to ensure you are ready

Meeting these requirements gives you a better shot at receiving coverage.

Getting Exemptions 

If insurance can’t cover weight loss surgery, exemptions can be made. If you can prove that you need the surgery for your health, then you may get preauthorization for the procedure. Insurance may only pay for a percentage of the surgery, but it’s better than having to pay out of pocket.  

What If My Request Gets Declined?

If your authorization is declined, you can appeal the decision. Some of the information you can include in this appeal include: 

• Ask your insurance for an explanation of their decision 
• Explain why you deserve to be covered
• Give a copy of the original doctor's letter for motivation

This appeal could force them to change the decision. 

Financing 

If you cannot receive coverage from your insurance company, your doctor could offer financial plans to assist you in paying for this surgery. Financing allows you to pay installments instead of a big chunk. Make sure that you are completely satisfied with the terms of financing, too.

Is It Covered? 

Some insurance companies do cover weight loss surgeries, but it will depend on the type of insurance and your history.  

Even if your insurance does not cover the operation, this is not the end of the line. Contact us today to find out more about financing options for weight loss surgery.