WEIGHT-LOSS SURGERY COSTS AND COVERAGE

Bariatric Surgery

Learn about bariatric surgery costs and financing options

Finance Information

One of the biggest concerns when considering bariatric surgery is financing the procedure. Common questions include the costs involved, insurance coverage, and how to convince your insurance provider to cover the weight-loss surgery.

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Overview

Today, many major health insurance carriers and companies recognize the long-term benefits of weight-loss surgery for clinically severe obesity, but others still do not. Review your policy, and call your insurance carrier to see if benefits for weight-loss surgery are provided in your policy. At this time, there are no standard coverage policies in the insurance industry for weight-loss surgery. Each policy has its own criteria for coverage.

Some common insurance requirements:

Body mass index (BMI) of 40 or 35 with health-related conditions
Recommendation for surgery from your primary care physician
Psychological evaluation from a licensed psychologist or psychiatrist
Nutritional evaluation from a licensed dietitian or nutritionist
Medical supervision by a physician for 3 to 6 months prior to surgery with preparation that includes diet, exercise, and nutrition counseling

All previous and current medical records associated with obesity related conditions
Records showing diet-attempt history including diet programs, journals, or physician-directed diet clinical notes. Some insurance companies require medically documented weight loss records before approving the surgery. Additional medical records and/or tests prior to surgery approval

Ask your healthcare provider about your insurance requirements for authorization.

Are You Covered?

For some patients, bariatric surgery is covered by your health insurance plan. However, every insurance policy is different, so it is important to know exactly what is and isn’t covered by your plan. Learn about your options and ask the right questions to find out what coverage is available to you.

Common requirements for insurance:

Past failure of a medical weight loss program
Weight problem for 3 to 5 years
Medical records for a period of time

Psychological evaluations and additional consults
Submission of paperwork for authorization

Questions to ask your insurance provider:

Does my policy cover the surgical treatment of severe obesity? If so, what procedures are covered?
Do I have to be referred by a primary care physician?
Is the hospital where I would have the surgery covered by this insurance policy?

What percentage of the procedure will the insurance company cover?
What deductible or percentage of the bill would I be responsible for?
What is the coverage for pre- and post-surgery treatment?

Questions to ask your HR manager if you don’t have insurance coverage:

Can the procedure be paid for by using partial payroll deductions?
Is it possible to change benefits at the next enrollment?
Will the employer assist with full or partial payment?

Additional options:

File an appeal with your insurance company
Explore self pay options
Explore other financing options
Try traditional, medically supervised weight loss programs

Potential Out-of-Pocket Costs

Information on this site should not be used as a substitute for talking with your doctor. Always talk with your doctor about diagnosis and treatment information.