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Insurance Coverage

Insurance Coverage

Many health insurance plans cover bariatric surgery, but every insurance plan is different. It is important to review your benefits carefully. Contact your insurance company to find out if bariatric surgery is covered and, if it is, which particular procedures are covered. You can also find out what your co-pays and deductibles are, plus if the hospital and surgeon you choose will affect your coverage.

It is likely that your insurance plan will stipulate that you go through a pre-approval process. Most insurance companies have requirements for people considering bariatric surgery that include:

  • Participation in a medically supervised weight loss program. You will probably have to take part in a total weight loss program that will include, exercise, diet, and/or medication. Some insurances require this to be supervised by a physician other than your surgeon. There is usually a period of time or number of sessions required.
  • A BMI of 35 or greater and comorbid conditions. A BMI over 35 is considered morbidly obese. A comorbid condition is a disease that is the result of, or strongly related to, a primary disease. Below is a list of common comorbidities of morbid obesity.
    • Arthritis
    • Sleep Apnea
    • High Blood Pressure
    • High Cholesterol
    • Type 2 Diabetes
  • Psychological evaluation provided by a licensed mental health care professional.
  • Patient is 18 years of age or older.

We can make this process easy for you. Our surgeon’s office will submit the required information to your insurance company. We can also arrange for referrals to needed specialists. Once again, it is important to check with your insurance carrier about the specific requirements. Each insurance company has multiple plans and coverage may vary.

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