Weight-loss surgery is becoming more and more popular as a solution for patients to enhance their health and quality of life. Are you considering bariatric surgery but concerned about the high cost? Wait we discuss Can I buy insurance to cover bariatric surgery?
What alternatives are available to you and whether it is possible to purchase insurance that will cover bariatric surgery are explained in this article.
So keep reading if you’re eager to learn more about your alternatives and discover ways to reduce the cost of bariatric surgery!
Does Insurance Cover Bariatric Surgery?
Almost all insurance plans cover bariatric surgery. All individual, family, and small group insurance coverage must cover bariatric surgery in 23 states.
For patients to be eligible for bariatric surgery coverage from the majority of insurers, their BMI must be at least 40 (or 35 with comorbidities).
Additional frequent requirements to prove the need for bariatric surgery include previous weight loss attempts, passing a psychological test, quitting smoking, and the absence of any signs of substance misuse.
What states require insurance to cover bariatric surgery?
23 states have mandated that all individual, family, and small group insurance plans provide coverage for bariatric surgery under the Essential Health Benefits (EHB) Benchmark Plans established by the Affordable Care Act (ACA). Those state names are as follows:
- Hampshire, New
- Jersey, New
- North Mexico
- A new York
- N. Carolina
- Dakotas, North
- Providence, RI
- Dakota, South
- North Carolina
Bariatric surgery coverage is also required by the ACA in the following three states, but not in all policies:
Georgia, where a state law passed in 1999 requires coverage for severe obesity.
In Indiana, a state statute passed in 2000 calls for coverage of morbid obesity.
In Virginia, each state-regulated health insurer is required to provide coverage for morbid obesity in at least one plan, according to a state law passed in 2000.
Does Medicare cover Bariatric Surgery?
Yes, Medicare may cover bariatric surgery if certain criteria are met. Medicare may cover bariatric surgery if:
- The patient has a body mass index (BMI) of 35 or higher.
The patient atleat have type 2 diabetes, high blood pressure, or sleep apnea.
Diet and exercise have not worked for the patient.
- The surgery is performed by a Medicare-approved bariatric surgeon.
How can I buy insurance to cover bariatric surgery as a Medical Necessity
Most insurance coverage require a medical reason for weight-loss surgery. In addition to your conversation, you’ll need to prove that each patient needs bariatric surgery.
The following requirements are common across insurance companies.
18 years age or older
Patients must normally be 18 years of age or older to undergo bariatric surgery. Most insurance policies exclude child bariatric surgery from coverage.
BMI greater than 40
In order to qualify for bariatric surgery, the majority of insurance companies demand that patients have a body mass index (BMI) of 40 or above.
Alternatively, those who are moderately obese and have comorbid conditions including high blood pressure, type 2 diabetes, clinically significant obstructive sleep apnea, coronary heart disease, or hypertension may be candidates of bariatric surgery if he has a BMI of minimum 35.
Attempted Weight Loss in Past
This may mean following the insurance company’s weight-loss plan or following a doctor’s advice. Insurance companies require three to seven months of continual programs or initiatives.
If your patient’s weight loss efforts fail beyond this period, bariatric surgery may be an option. You have to provide weight loss efforts including food and exercise plans to receive insurance approval.
Before approving your patient for bariatric surgery, the majority of insurance companies will also demand that they undergo a psychiatric examination. This ensures patients have realistic expectations for the surgery’s results and the knowledge and support they require to succeed long-term.
The psychological assessment will consider:
- justifications for undergoing bariatric surgery
- History of weight and diet
- present-day eating habits
- Understanding the procedure and the lifestyle modifications it entails
- Social backing and background
- Psychiatric background
Quit Smoking and Avoid Substance Abuse
Finally, the majority of insurance companies will require that your patient discontinue smoking and show no indicators of substance misuse or have a recent history (within the previous five years) of substance abuse before they would pay for bariatric surgery.
Patients must be medically cleared for surgery by their primary care physician or other healthcare provider.
The patient must have one or more weight-related health problems, such as high blood pressure, type 2 diabetes, or sleep apnea.
Best Health Insurances that Cover Weight Loss Surgery
Can I buy insurance to cover bariatric surgery | Questions to ask before buying
- Can I pick any medical facility or surgeon to perform my weight loss surgery?
- How much of a deductible will I be required to pay each year?
- Do copays come with weight loss surgery insurance?
- Does the medical plan pay for the price of prescription medications?
- What paperwork is needed to be eligible for bariatric coverage?
- How long does it take until my coverage starts?
- If my claim is rejected, what is the dispute resolution procedure?
How to get insurance to cover revision bariatric surgery
If you are seeking revision bariatric surgery and wondering how to get insurance coverage for it, there are several factors to consider. Insurance companies will ask if the previous surgery failed. They will inquire if the patient was in violation with guideline such as overeating or not following dietary advice.
Insurance companies require BMI report or weight, and documentation of previous weight loss attempts. If you do not meet these requirements it may be helpful to seek support from Obesity Action Coalition organizations.
Ultimately, the specific cause of weight regain after your initial gastric bypass surgery may determine the type of revision procedure recommended, as well as the associated costs . Keep in mind that even if your doctor recommends revision bariatric surgery and you meet the qualifications, insurance companies may still deny coverage . However, by working closely with your healthcare provider and insurance company, you may increase your chances of getting the coverage you need.
What are the insurances that cover bariatric surgery?
The insurance companies that cover bariatric surgery vary depending on the specific policy and requirements.
If the patient qualifies, most insurance coverage cover bariatric surgery. Aetna, Cigna, United Healthcare, Blue Cross Blue Shield, and Medicare are some prominent insurance carriers that cover bariatric surgery.
Even if your plan covers bariatric surgery and you meet weight and health requirements, you claim may not be accepted.
Most insurance companies require certain criteria for approval, which may include documentation of prior weight loss efforts, a psychological evaluation, and a letter of medical necessity from your doctor. It’s recommended that you contact your insurance provider to find out if they cover bariatric surgery and what requirements they have for approval.
How to qualify for bariatric surgery?
Bariatric surgery may be a viable option for individuals who have not achieved significant weight loss through traditional methods and have a high body mass index (BMI). Here are some of the qualifications and requirements for bariatric surgery:
- BMI of 40 or higher, or extreme obesity.
- Type 2 diabetes, high blood pressure, and severe sleep apnea are just a few of the serious health problems associated with obesity (BMI 35-39.9).
- A BMI of 35 or more, one obesity-related medical condition and six months of supervised weight loss.
- Having a BMI of 40 or higher, 35 or higher with one or more significant obesity-related health conditions, such as type 2 diabetes or sleep apnea, and 30 or higher with at least one such condition.
- 35 or higher BMI, or 30-35 with an obesity-related ailment such heart disease, diabetes, high blood pressure, or severe sleep apnea.
- Before, patients had to meet the requirements for surgery, which included a BMI of 40 or 35 and one obesity-related medical condition.
- a BMI of 30 to 39.9 and a serious obesity-related health problem, such as diabetes, high blood pressure, sleep apnea, high cholesterol, joint problems, etc. Insurance has stronger requirements and a BMI requirement of 35 or higher.
- Gastric bypass, adjustable gastric bands, and biliopancreatic diversion are all types of bariatric surgery. Restrictions on eating lead to weight loss.
- For consideration for weight loss surgery, patients must have a BMI of 40 or 35 and weight-related health concerns. Aside from type 2 diabetes, obesity can also result in high blood pressure, high cholesterol, sleep apnea, hypertension, heart disease, stroke, and other health problems.
- Before, during, and after surgery, a multidisciplinary bariatric surgery team offers personalized care. Dietitians, psychologists, exercise specialists, and bariatric surgeons can all be of assistance.
Bariatric Surgery Types
Bariatric surgery refers to a wide range of surgeries. Some of the typical ones are listed below.
- Sleeve gastroplasty
- a little gastric bypass
- Weight Loss Surgery
- Adjustable Banding your stomach
- Surgical Port Reduction
- The Gastric Bypass Roux-en-Y
What will happen if your Bariatric Surgery is delayed?
Bariatric surgery may result in additional health issues if it is delayed. Some of the effects of delaying the surgery are listed below.
- Hypertension might appear.
- Heart health could deteriorate
- could lead to type 2 diabetes
- blood pressure rising
- Also, cholesterol levels could rise.
- Disorders of sleep may result.
Documents required to submit a bariatric surgery claim
You might need to present the following records to your insurance in order to file a claim for bariatric surgery.
- Medical data revealing a past history of obesity-related health issues.
- There is proof that you changed your diet and lifestyle to lose weight.
- evidence of unsuccessful weight-loss attempts when getting medication therapy (if applicable).
What insurance companies cover weight loss surgery
Bariatric (weight loss) surgery is covered by several US insurance companies.
Your insurance plan and state will decide your coverage and requirements.
Some of the insurance companies that may cover weight loss surgery include:
- State Farm
- Blue Cross Blue Shield
- United Healthcare
- Kaiser Permanente
Can I buy insurance to cover bariatric surgery | Article Conclusion
In conclusion, purchasing insurance to cover bariatric surgery is possible, but it is important to understand that coverage varies depending on the insurance provider and policy. To increase the chances of coverage, it is recommended to have a physician or surgeon request pre-approval and to explore different insurance options that fit one’s needs and budget.