Does Medicaid Cover Weight Loss Surgery?

For some people weight loss surgery is the only solution to an obesity issue that is out of control. Many have tried other forms of weight loss programs and management with no success. Choosing a weight loss surgery may be the only answer to attaining a healthy weight and lifestyle. These surgeries can be costly and may be out of reach for many people. The cost for bariatric surgery varies based on the type of surgery, patient and location of the surgery. The surgery could cost between $17,000 and $30,000.

Screenshot of services covered

Medicaid does cover weight loss surgery in most cases as long as the patient fits the criteria for coverage. Each state is individual in their coverage and you will need to verify with your state what their coverage is. The guidelines set-out in the Medicaid coverage do not specifically mention bariatric surgery, but it is usually handled on a case by case basis. The surgeries do require that the patient fit some set criteria for the coverage. The process for being approved for Medicaid coverage of your weight loss surgery involves working with your physician.

What is covered?

When coverage applies Medicaid does cover gastric bypass, gastric sleeve surgery and Lap-Band Surgery in most cases. These surgeries are among the most popular and are more readily accepted by Medicaid as being medically vital to a patient’s life in certain situations.

  • Gastric bypass is a procedure that essentially bypasses a part of your intestine sending food straight to the lower intestine. This procedure also reduces the size of the stomach allowing for less food to be eaten. In bypassing a portion of the digestive process, the body will not absorb as many calories or nutrients. This will result in weight loss along with the smaller intake of food.
  • Lap-Band surgery is accomplished by placing a band made of silicon and containing balloons around the top part of the stomach. This makes less space for holding food and makes the entrance for food going into the stomach smaller. The procedure is done laparoscopically and is minimal invasive compared to other surgeries. The band is adjustable and the procedure is reversible.
  • Gastric sleeve surgery is the process of creating a smaller stomach that is shaped like a sleeve. This gives the food a smaller space to sit in and also directs the food downward through the intestines. This procedure reduces the amount of food that can be put into the body and is generally not considered to be reversible.

In most cases, if they agree to cover the individual patient for the procedure, they will cover all of it. The process for obtaining coverage can be frustrating if you are not prepared. Remember to be patient and follow some steps to getting the coverage that you need.

How much is covered?

In most cases, if the surgery is covered by your Medicaid, there will be full coverage available. If there is some part of the surgery that is not covered, you may be able to turn to other supplemental insurance or gap insurance for coverage once you have been approved by Medicaid for the surgery. This could help to push through coverage of any remaining balance with other insurance carriers.

The Process for Surgery Approval

Medicaid.gov LogoIf your state Medicaid covers bariatric surgery the first step you will want to take in getting approval for your situation is to meet with your physician. Medicaid typically requires that there is a medical need for the surgery in order to provide coverage. It is vital that your physician is able to provide information to them regarding your situation and the medical need for the surgery. The physician can then refer you to an approved surgeon to assess your situation.

When meeting with an approved surgeon they will go over the basics of the surgery and discuss your options. Once you have decided they can run various tests to check out your medical health to go through surgery and then ask for a pre-approval of the surgery from the Medicaid office. This process can take a good deal of time and you will want to try to be patient.

Medicaid and the surgeon may require that you attend classes that discuss the surgery, proper nutrition, exercise and how to make lifestyle changes after the surgery. This is often required before they will allow you to have the surgery or start the process. This is to ensure that you fully understand what is going to happen and what your role in your success after the surgery is going to be.

Medicaid may approve of the surgery with some provisions that need to be met. This could be further testing, additional classes or added information to the file. The surgeon can work with you to accomplish these requirements.

If Medicaid approves the surgery the surgeon will likely need to confirm your ability to undergo surgery at the time. This could mean x-rays, blood work and some medical preparation. The surgery will then be booked and you will be on your way to reaching your goal weight.

It is hard to determine what part of your surgery if any will be covered by Medicaid in your area. You can check with the local Medicaid office to see where this information is listed locally for you. Make sure that if there is a requirement to use an approved surgeon that you have a list of these surgeons. Each office should be happy to provide you with useful information to get these answers.

Essentially, if weight loss surgery is found to be necessary for improving your health or avoiding a catastrophe, the Medicaid in your area may be willing to cover the expenses.

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