Will Insurance Pay For Bariatric Surgery?

By Etwar McBean, MD, FACS

The Bariatric and Hernia Institute, PC

. http://www.tbhinstitute.com/

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Will Insurance Pay For Bariatric Surgery?

Many insurance companies provide coverage for bariatric surgery (weight loss surgery). However, the coverage may vary between the plans offered by a particular company. For the person considering bariatric surgery, it is important to find out if the enrolled plan offers the coverage. Additionally, the plans that provide coverage have specific criteria that a person must meet before the coverage will be approved.

Basic Criteria

Bariatric surgeries, such as gastric bypass and sleeve gastrectomy, are reserved for individuals who are morbidly obese and are suffering from the health consequences of obesity. Insurance coverage is generally provided when someone is at least 100 pounds over their ideal weight. This means having a body mass index (BMI) of at least 40. A person with a BMI between 35-40 can also receive coverage if the person has obesity-associated health problems requiring treatment such as diabetes, hypertension, and sleep apnea.

Support from a primary care physician is important, as insurance companies will be looking for a recommendation for bariatric surgery from a personal physician.

A documented history of weight loss efforts will be necessary as most insurance companies will not offer bariatric surgery as the first line of treatment for weight loss. Patients considering weight loss surgery must have already been involved with a medically supervised weight loss program. This may be with a primary care physician, a weight management specialist or with a dietitian. Patients are often required to have a documented history spanning six months on average with consecutive monthly visits. Patients who lose weight during that period are more likely to receive insurance coverage.

Psychological evaluation is a major component of the insurance requirement. Patients need to be evaluated to ensure that they are mentally prepared to undergo such a life-changing procedure. It is also necessary to uncover any underlying issues that may be a barrier to success.

It addition to the basic criteria, patients may be required to undergo additional medical evaluation, investigations and procedures to ensure that they are good surgical candidates. For example, many patients are required to undergo a sleep study to diagnose untreated sleep apnea. The evaluation process for bariatric surgery is generally outlined after consultation with a bariatric program.

The results from bariatric surgery are based on using the procedures as a tool and a commitment to lifestyle changes that promote weight loss and healthy living.