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Gastric Bypass Insurance
Insurance coverage for your Gastric Bypass surgery is a significant consideration and aspect to scheduling your surgery. Most adults cannot afford the expenses that go along with weight loss surgery.
Because of this reality, you need to use your insurance to have your necessary weight loss surgery.
Before scheduling your surgery, there are many insurance requirements that you need to meet before scheduling. This entire period to become accepted by your insurance takes about three years.
It takes a large amount of time for surgery to be scheduled due to a variety of factors. For your insurance to cover your Gastric Bypass, you need to look at your specific insurance policy, not just your insurance carrier.
Most insurance carriers offer some aspect of weight loss surgery coverage, but your specific policy determines what is explicitly covered and what is not. Some policies exclude weight loss surgery, and others charge you are more for weight loss surgery.
You can check to see if your policy covers weight loss surgery, specifically Gastric Bypass, by directly calling your carrier. This number is usually on the back of your insurance card.
The average cost of Gastric Bypass surgery is $23,000. Because of this considerate financial investment, you need to make sure that your insurance can adequately cover all of your surgery. Most adults cannot pay for their weight loss surgery out of pocket.
Because of the large increase in obesity in adults, insurance companies are beginning to increase their coverage for weight loss surgery. There is also evidence that weight loss surgery to treat morbid obesity is more cost-effective than treating health conditions resulting from obesity.
Although the average cost of Gastric Bypass is $23,000, this cost does vary depending on a multitude of reasons. The reasons include:
- Weight loss surgery
- Surgery circumstances
- Surgery complications
The positive result of weight loss surgery is that the surgery reduces your health care costs and improves your ability to work more efficiently. Because of these reasons, your health care plan typically approves your surgery if you meet the specified standards.
Most health insurers do pay for Gastric Bypass if you meet their specific requirements. Insurance companies deny roughly 25% of their patients before approval. Because of the strict requirements, you may have to go through some hoops before you qualify.
Two major insurance companies you can consider are Aetna and CIGNA. Medicare also covers some weight-loss surgeries that include Gastric Bypass. For Medicare to cover your weight loss surgery, you will need to meet some requirements.
The requirements include:
- BMI of 35 or higher with a comorbidity
- Attempted a weight loss program in the past unsuccessfully
The approval process for Medicaid when you meet their criteria can take a bit of time to process.
Your insurance can approve your surgery as quickly as one month or take up to five months or longer.
During the approval process, Medicaid will analyze your health records and speak with your doctors to decide.
Does Aetna Cover Gastric Bypass?
Aetna considers Roux-en-Y gastric bypass (RYGB) medically necessary when the selection criteria are met.
The required criteria for Aetna coverage include:
- Morbid obesity for a minimum of 2 years
- BMI of 40 or more
- BMI of 35 with comorbidity of
- Type 2 diabetes
- Sleep apnea
- Heart disease
- Attempted weight loss without success in the past
- Followed a nutrition plan and exercise program supervised by a doctor
Following the criteria and meeting their base standards improves your likelihood of receiving your gastric bypass surgery coverage.
CIGNA does have bariatric surgery coverage available in their group medical plans. You can choose whether or not to include it in your medical plan. Most of the CIGNA customers have weight loss surgery in their coverage plan.
The requirements for bariatric surgery coverage include:
- Minimum of 18 years old
- BMI of more than 40 for the last 2 years or,
- BMI of 35-39.9 for 2 years with a comorbidity
- Sleep Apnea
- Heart disease
- Participation in a weight management program in the past 2 years
Suppose you can meet all of these requirements, then you will have your surgery covered. Suppose you are not able to, then your insurance will deny you.
After your approval for surgery, you may find that your weight loss has stalled at a particular weight.
This is perfectly normal after Gastric Bypass. If you have had significant weight loss, you will most likely experience loose skin.
Loose skin is a natural part of weight loss. Most bariatric patients who have lost over 50 pounds since their surgery have loose skin. If your loose skin impedes your mental and physical health, you may qualify for skin removal surgery through your insurance.
To be approved for skin removal, you need to have remained at a consistent weight for the past 6 months without significant weight gain or loss. After meeting this standard, you have to document through doctor’s visits that you have tremendous trouble with your current skin condition.
Usually, skin conditions that meet insurance standards for surgery include:
- An abundance of rashes or ulcers
- Skin irritation that has not improved with treatment
Most insurance companies are strict concerning meeting specific surgical requirements. Your skin removal surgery will only be covered by insurance if it is deemed medically necessary. Medical necessity is only apparent when your excessive skin interferes with your daily activities.
If you cannot show that your excessive skin interferes with your daily activities, you will have to pay out of pocket.
Insurance companies typically cover bariatric surgery with specified requirements. These requirements usually include looking into your medical records to document your medical problems due to excessive weight.
Insurance companies also want to see participation in a medically supervised weight loss program.
Most insurance companies require 3 to 6 months of participation in a medically supervised weight loss surgery within 2 years of your scheduled bariatric surgery date.
If your insurance denies you, you can always appeal. The appeal process is to determine and prove whether bariatric surgery is medically necessary. If you are still denied coverage after an appeal, you can always use other methods, including:
- Credit Cards
- Medical Loans
- Large sum payment
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