Bariatric Weight-Loss Surgery

Weight Loss Surgeries: Are They Covered By Insurance?

Dr. Jason F. Moy
Dr. Brian T. Chin
Daniel Roman
October 19, 2023
Weight Loss Surgeries: Are They Covered By Insurance?

If you’ve ever considered getting weight loss surgery, you might have wondered, “How much does weight loss surgery cost?” Luckily, most insurance companies will partially cover major bariatric surgeries such as gastric bands, laparoscopic gastric bypass, and gastric sleeve surgery.

There are many factors to consider when looking into the cost of weight loss surgery. Insurance coverage varies for each company. You will need to know which types of surgery are covered, the required criteria before each procedure is approved for coverage, and how to move forward with getting approval. 

Criteria for Weight Loss Surgery Approval

Many insurance companies require you to meet certain criteria to be approved for bariatric surgery. Class III Obesity usually qualifies a person for weight loss surgery. Class II Obesity will often qualify a person if there is comorbidity such as type 2 diabetes, cardiovascular disease, or life-threatening cardiopulmonary conditions like sleep apnea.

Sometimes insurance companies will require that you prove that you have attempted to lose weight through a diet plan or program. Also, providers often require that you are 18 years of age or older, but covered procedures for adolescents are possible if they meet their own set of criteria. Other criteria you might come across include passing a psychological evaluation to ensure your mental health will not complicate the process, consulting with a weight loss surgeon, quitting smoking before the procedure, and/or showing a willingness to take part in a post-procedure weight loss plan.

If your provider does not typically cover weight loss surgery, it is often possible to prove that bariatric surgery is a medical necessity for you and be approved on an individual basis. You also may want to consider options such as upgrading to a different insurance policy or carrier.

The Cost of Weight Loss Surgery

The average total cost of gastric bypass surgery is $23,000, the average total cost of a lap band is $14,500, and the average total cost for gastric sleeve surgery is $14,900. Most people cannot afford to pay those amounts in total, and for that reason, insurance companies often at least partially cover weight loss surgery. While they have been considered “too experimental” in the past, weight loss surgeries today are considered more acceptable and essential than ever. Some states even have laws requiring insurance companies to cover weight loss surgery for patients who meet specific criteria.

If your insurance covers surgery, that provider will usually pay over 80% of the cost, which means you can expect to pay a maximum of around $4,600 to $3,000 out of pocket.

Another thing to keep in mind is that although most insurance carriers will cover weight loss surgery, not every policy will. You will want to check your policy details because some insurance companies charge a higher premium to include coverage for bariatric surgeries. 

Most doctors suggest calling your carrier directly to determine whether your surgery is covered under your policy and exactly how much your insurance will pay. You can find their number on the back of your insurance card.

At the Bass Bariatric Surgery Center, we know that planning a weight loss surgery can be overwhelming, especially when looking at its costs. You may be wondering if surgery is your best option, which surgery would be most beneficial, and how to take your first steps in your weight loss journey. We hear you, and we are here to help! Our specialists are here to answer all of these critical questions and provide you the care and guidance you deserve. Call us today at 925-281-3711 to learn more or schedule a consultation.

About The Author

Daniel Roman, Content Writer

Daniel Roman is a Digital Content Writer at BASS Medical Group. He received his Masters in Journalism from UC Berkeley in 2021. Daniel has published multiple newspaper articles covering public health issues. His latest was a magazine cover story on pandemics and diseases that he co-wrote with Dr. Elena Conis, a historian of medicine, public health, and the environment.

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