Will insurance cover weight loss surgery? The answer is not so simple. What variables do you need to consider? And what if your out-of-pocket expenses are just too much even with coverage? Here’s a quick primer on using insurance to pay for bariatric surgery.
Most Insurance Policies Offer Coverage for Weight Loss Surgery
Most insurance policies will cover weight loss surgery if you meet certain criteria. Your policy may require that the procedure be deemed medically necessary and to diagnose a specific medical condition such as morbid obesity or diabetes, but most insurers will agree to at least this first level of coverage for those meeting their qualifications.
What Qualifications Might I Have to Meet?
Your insurer might ask that you try less invasive methods before considering more major procedures like gastric bypass, sleeve gastrectomy or lap banding. Insurers also usually won’t approve bariatric surgery until your weight loss efforts have been proven ineffective. They want to see that you tried everything you could besides surgery, including medications and behavioral changes intended to produce sustainable weight loss.
They also typically ask that you have at least a BMI of 40. They sometimes lower the threshold to 35 if you have a comorbidity, and 30 if that comorbidity is currently causing significant problems for you.
Insurance Companies Sometimes Have a Preference for Which Procedure You Choose
While insurers will cover most weight loss surgeries, they may have a preference as to which one you choose. If your policy mandates coverage for gastric bypass surgery, for example, and you’d rather have sleeve gastrectomy surgery because of potential health risks associated with gastric bypass surgery, your insurer might not cover the procedure. This is why it’s important to read your policy carefully or speak with an insurance representative before making any decisions about surgery.
What if My Out-of-Pocket Expenses Are Still Too High?
Even with insurance coverage, many people find that their out-of-pocket expenses are still too high for them to afford the surgery. If this is the case, and you’re considering bariatric surgery in Mexico as an option for less than your out-of-pocket expenses to still get the benefits of obesity treatment, we can help.
Our comprehensive packages cover everything from your procedure to your nursing care and hotel stay, and all for a fraction of the cost of surgery in the US. So, if you either don’t have coverage or the out-of-pocket costs are too high to afford, talk to Dr. Jalil.
Worried about maintaining results after your procedure? Read: How to Manage Your Cravings After Weight Loss Surgery.
