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What Bariatric Surgeries Are Covered By Insurance?

i Jun 6th No Comments by

Bariatric surgeries are effective at helping obese patients who haven’t otherwise been able to lose weight find a medical solution that is proven effective at supporting weight loss. For many, it is a lifesaving procedure, but due to their high costs, most patients need their health insurance carrier to help them pay for the surgery.

Which Bariatric Surgeries Are Covered by Private Insurance?

Every insurance provider is different. You’ll need to check with your insurance provider to see if your policy covers bariatric surgeries. Most will cover these four types of weight loss surgery for select patients that have approval from their doctor:

  • Gastric Bypass – Perhaps the most well-known bariatric surgery, gastric bypass is where the surgeon cuts the stomach and staples it to create a small pocket at the end of the esophagus. This pocket is then connected to the small intestine. The remainder of the stomach is left connected to the top of the small intestine so that the digestive juices can still break down food.
  • Lap Band/Realize Band – With adjustable gastric banding, or LAP band, a silicone is sewn around the top of the stomach. Around the inner surface of the band is a tube. The LAP band reduces the size of the stomach so that the patient gets full faster. On subsequent visits, doctors can add or remove saline solution to this band, restricting or increasing the patient’s appetite.
  • Gastric Sleeve – Gastric sleeve is one of the most common newer options for bariatric surgery, and easily one of the most effective. With gastric sleeve, the stomach is divided to create a large pouch that connects the small intestine to the esophagus. This pouch is then stapled shut and 75% of the remaining stomach is removed.
  • Duodenal Switch – Reserved for those that need substantial weight loss, the duodenal switch both shrinks the size of the stomach, and involves cutting the small intestine into parts so that food travels faster down the small intestine and has less time to process. Other techniques, such as the gastric balloon, are rarely covered by insurance because many consider it to be experimental. Every insurance carrier has different requirements and may decide to alter their stance on different types of surgery and what it takes to qualify. For example, most of the Blue Cross/Blue Shield network provides coverage for all four types of weight loss surgeries for patients with a BMI of 40 or greater, or above 35 if you have at least two comorbidities. United Healthcare, on the other hand, covers most patients with a BMI over 35 but only requires one comorbidity and requires a psychological evaluation. You can find some information on the top insurance companies below:
  • Kaiser Bariatric Surgery Coverage
  • United Healthcare Insurance Coverage
  • Blue Cross Insurance Coverage
  • Cigna Insurance Coverage
  • Aetna Insurance Coverage

However, it is important to note that not everyone’s policy covers bariatric surgery. You have to check your individual policy. Large organizations often work directly with health insurance agencies to decide what to offer their workers, and not all will opt to provide weight loss surgery coverage.

Some states may also require that health insurance companies cover bariatric surgery. These states can be found here, and include Arizona, California, and Illinois. However, it should be noted that complementary treatments may not be included. For example, some states that are required to offer bariatric surgery are not required to pay for the costs of anesthesia, or for the hospital stay.

With most insurance companies, minors may be considered, but further conditions apply.

Surgeries Covered by Medicare and Medicaid

In some states, Medicaid covers bariatric surgery. Medicare will cover it in all states, but the patient must meet the following requirements:

  • A BMI above 35
  • At least one co-morbidity connected to obesity
  • Documentation that previous medical treatments for obesity failed

Documentation is often the most difficult part. But if a patient meets these requirements, Medicare will cover gastric bypass, Lap band, duodenal switch, and gastric sleeve surgery

Contact Your Insurance Company Today

Each insurance company has multiple policy types, so while an insurer may cover weight loss surgery, it’s also possible that you, specifically, may not have that coverage. Make sure you check with your specific insurance representative to determine if it is covered by your policy.

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