Kaiser Requirement for Weight Loss Surgery

In order to qualify for the coverage of your weight loss surgery with Kaiser Permanente, you need to make sure that your individual policy includes its coverage. Kaiser does offer policies that cover this type of surgery, but not all of them will. In order to find out whether or not your individual policy covers this type of insurance, you may need to directly contact Kaiser Permanente.

The weight loss surgeries that some Kaiser plans do cover include Lap-Band, Gastric Bypass, and Gastric Sleeve provided that you meet all of the specific requirements that Kaiser has before giving coverage.

Kaiser Permanente’s Requirements for Weight Loss Surgery Coverage

Kaiser Permanente will cover weight loss surgery in many cases, but there are specific criteria that you need to meet in order to qualify. Namely:

• You need to have a Body Mass Index (BMI) that is 40 or greater
  • You need to have a Body Mass Index that is 35 or greater and paired with major comorbidity
  • Major comorbidities can include but are not limited to high cholesterol, diabetes, and sleep apnea.
• You need to be 18 years old or older.
• You need to have completed a medically supervised program for weight loss within two years of applying for weight loss surgery.
• You need to fall into the category of “morbidly obese” for three of the last five years. This is something that needs to be documented by a physician, which means during family doctor or OB/GYN visits you should make sure that your weight is being documented accurately.
• You need to successfully complete a psychological exam. This is imperative in ensuring that you will stick to the lifestyle changes required for weight loss following weight loss surgery.

Kaiser Permanente Covers the Following Surgeries

These are the most commonly covered types of weight loss surgery, and Kaiser Permanente covers them all as well. These include:

• Gastric bypass surgery
• Lap Band surgery
• Realize Band surgery
• Gastric Sleeve surgery
• Duodenal Switch surgery

Kaiser Permanente Does NOT Cover the Following Surgeries

• Gastric plication with gastric band
• Gastric plication without gastric band
• ‘Mini’ gastric bypass surgeries
• Trans-oral stapling surgeries

It is important to know that Lap Band fills are also covered, provided that the original procedure was covered by your insurance. If your insurance covers your Lap Band or Realize Band operation, then subsequent band fills, necessary for the adjustment of your band, will also be covered.

Facility Options with Kaiser Permanente

As is typical for patients covered by Kaiser Permanente, you need to remain in-house with this type of procedure. That means that when you decide to have weight loss surgery, you will need to undergo the procedure at a Kaiser facility. This is the best way to make sure that everything you need to have done is completely covered by your insurance policy before you have the surgery.

The Bottom Line

Kaiser Permanente does offer coverage for weight loss surgeries, provided that your individual plan offers the coverage that you need. The most common weight loss surgery procedures are covered by Kaiser Permanente, including the Lap Band, the Realize Band, the gastric bypass, and the duodenal switch. Kaiser Permanente does not cover all types of weight loss surgery. Make sure when you are considering weight loss surgery that you ensure it is covered by your policy first and foremost, then make your arrangements accordingly. Your surgeon will work closely with Kaiser Permanente to make sure that all of your care is covered.