Join Facebook Group

As an Amazon Associate, BariBuilder earns from qualifying purchases.

6 Weight Loss Surgery Insurance Secrets You Need to Know

6 Weight Loss Surgery Insurance Secrets You Need to Know

Weight loss surgery is costly, and getting your insurance company to cover your surgical costs is no easy task. However, the cost of not going through with surgery is often much more significant for both you and your insurer. If you are considering bariatric surgery but are unsure how to pay for the procedure, you have come to the right place. Here are 6 weight loss surgery insurance secrets that will help you get coverage so that you can reclaim your health and wellbeing.

Secret #1: Work With Your Bariatric Surgeon To Get Coverage

Even if your insurance policy offers bariatric surgery coverage, there is no guarantee that you will qualify for coverage for your surgery. There are also several different hoops you must jump through even to be considered for coverage. For example, most insurers require you to meet the following requirements before considering your request to have bariatric surgery:

  • BMI greater than 35 with at least one comorbidity related to obesity; or
  • BMI greater than 40 with no additional health problems (you can calculate your BMI here).
  • Proof of participation in a weight management program that is supervised by a doctor or clinician
  • Letter of medical necessity
  • At least one statement of recommendation for bariatric surgery from a physician besides your bariatric surgeon.
  • Medical approval or clearance for surgery
  • An evaluation and approval for surgery from a mental health doctor
  • Evaluation by a registered dietician

Fortunately, most bariatric surgeons and their staff will help guide you through the insurance process at no additional cost to you. Bariatric physicians offer this service because they know that cost is one of the major factors that prohibit patients from pursuing weight loss surgery and meeting their health goals.

Work together with your bariatric surgeon and their team to figure out how to get insurance to cover bariatric surgery.

As you can see, there are many steps you need to take to request coverage, so start working with your surgeon early on to get your insurer to pay for your weight loss surgery.

Secret #2: Add a non-network surgeon to your insurance network

Most insurance companies have certain providers they include in their network for coverage. If your bariatric surgeon is not in your network, you can request to have your surgeon added. However, this process can take some time, so make sure to get a jumpstart on adding your physician to increase your chances of weight loss surgery insurance coverage.

If you have Medicare or Medicaid, the process is likely different. However, it is important to note that Medicare does cover some weight loss surgery expenses, like gastric bypass and lap band.

Secret #3: Work to get partial coverage of your pre-surgical services if your insurance company does not cover bariatric surgery

If you are struggling to get health insurance covering weight loss surgery, see if you can get at least some (or all) of your pre-surgical tests and appointments covered. People pursuing bariatric surgery need several tests to verify they meet medical requirements and approval for weight loss surgery. These tests can include:

  • Blood work
  • Cardiology exam
  • Sleep studies (to test for sleep apnea, etc.)
  • Medically supervised diet program, and
  • Mental health exam

If you do not have insurance coverage for weight loss surgery, your insurer may not pay for pre-surgical tests if these services are billed as pre-bariatric surgery procedures. Fortunately, your provider can bill most of these procedures as health-related needs unrelated to weight loss surgery. So, make sure your doctors know your insurance will not cover anything related to bariatric surgery.

You will need to have several tests and exams before you can have bariatric surgery.

Secret #4: Your state may require your insurance carrier to cover weight loss surgery

Per the Affordable Care Act, many states require insurance companies to provide bariatric insurance for weight loss surgery. If you live in a state that does not mandate bariatric surgery insurance, you will likely have a more challenging time obtaining coverage.

Per the National Conference of State Legislatures (NCSL), as of 2019, 33 states offered coverage for the diagnosis and treatment of obesity. Additionally, obesity is now a medically recognized disease in these states. As part of this change in legislature, 23 states require insurance companies to offer some form of coverage for weight loss surgery. Furthermore, 16 states now require coverage for nutritional counseling and therapy. For a detailed list of bariatric surgery insurance requirements per state, visit the NCSL website.

Secret #5: Your place of employment may be able to add weight loss surgery insurance to their company plan

If you work in a larger company that carries an insurance plan, you may be able to work with your HR department to change your insurance policy to include weight loss surgery. Companies with 51 or more full-time employees have more leverage to make these changes.

To get started, meet with an HR representative. Let them know your situation. Specifically, include information on how weight loss surgery inclusion can benefit their company as a whole. Taking your personal experience and emotion out of your discussion can increase the likelihood your case will be presented to the human resources department's decision-makers. Therefore, you will want to talk about how weight loss surgery can improve their employees' health and wellness, decrease insurance costs overall, and improve their staff's productivity.

Giving employees access to insurance that covers weight loss surgery can save your company money on their end.

Secret #6: Find creative ways to reduce your out-of-pocket costs

If you do not have complete weight loss surgery insurance coverage or no coverage whatsoever, there are ways you can decrease your costs. Here are some possible avenues you may want to explore:

Discounts for self-payment - Some providers will offer a discount or payment plan for patients who cannot get insurance coverage for weight loss surgery. Ask your physician if they provide this service.

Discounts for paying in advance - If you can pay for your surgery ahead of time, your surgeon may offer a discount. Again, ask your doctor if this is an option their practice offers.

See if you can have your surgery at a less expensive hospital - Hospital costs are the biggest expense of your total bariatric surgery bill. Some surgeons can operate at multiple hospitals. If your surgeon has privileges at other hospitals, see which hospital has the lowest bariatric surgery fee.

Medical tax deductions - The IRS will deduct your medical expenses if your expenses are greater than 10% of your adjusted gross income. This means you can have a break on your taxes for paying for your medical costs.

Hospital fees are the greatest expense for most bariatric surgery patients.

The Bottom Line of Getting Weight Loss Surgery Insurance

There is no doubt about it: weight loss surgery is expensive. It can cost between $14,000-$33,000 unless there are complications. The type of surgery you get also determines the cost. For example, gastric bypass and duodenal switch tend to cost more than gastric sleeve or a lap band procedure.

Although surgery is costly, your health care expenses will likely be far greater if you do not take action to lose weight. Comorbidities associated with obesity are extremely expensive and take a toll on your body. For example, people with obesity often also struggle with:

  • Diabetes
  • Cardiovascular disease
  • Kidney disease
  • Sleep apnea
  • Osteoporosis
  • Depression

People who do not take action to lose weight can spend a tremendous amount of money on doctor's visits, lab work, medications, and hospital stays. Don't let lack of insurance coverage stand in your way of meeting your weight loss goals. Meet with your bariatric surgeon to learn the steps you need to take to begin your weight loss journey.

Want to discuss this article or ask a question? Join our Facebook community of peers just like you.

Julia Rae Walker, RN, BSN, BA

Author

Julia is an experienced critical care nurse with a background in pediatric and adult patient populations. Her passion is helping patients maximize their quality of life.

Gintas Antanavicius, MD, FACS, FASMBS

Medical Reviewer

Dr. G is a co-founder of BariBuilder. A US-based expert surgeon with over 10 years of bariatric experience, he regularly publishes research in medical journals like SOARD, Obesity Surgery, etc.