How to get insurance to pay for weight loss surgery

by Janice Crane
(Alexandria, NH)

How do I qualify for weight loss surgery so that insurance will pay for it?

I am a 57 years old with a history of chronic back pain, depression and high blood pressure. I have a family history of diabetes, strokes and osteoarthritis with joint replacements.

My weight is 215 pounds and has been this way for the past 10 years. Physically I do walk, but after doing it I hurt, standing in one place for very long I hurt, and also after sitting I hurt. I do swim for exercise when I can get there which is 30 minutes away.

I eat a good diet and I am not a big eater. My downfall on eating is bread and sweets. So with no children in the house I do not bake. My husband and I eat the same foods and in a year's time his cholesterol went down 25 points with no drugs except for dietary supplements.

I do believe if the weight is off I could maintain it and I would feel better. What do you think?

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How to get insurance to pay for weight loss surgery

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Getting insurance to pay for weight loss surgery NEW
by: Jeff

Hi Janice,

Assuming that you've calculated your body mass index (BMI) to be at least 40 or at least 35 alongside at least one clinically significant comorbidity, getting insurance (in the United States) to pay for weight loss surgery really depends on your employer. Individual plans do not usually cover it, unless you have Medicare, in which case weight loss surgery is covered for individuals.

Assuming you have insurance through your (or your partner's) employer, the easiest way to find out if it's covered is to review your plan documents, speak with your Human Resources department or contact your insurance company.

If you find out that it's covered, click here to learn the next steps for getting insurance to pay for weight loss surgery.

If you find out that weight loss surgery is not covered by your employer-sponsored plan and want to try to convince your company to add it, there are several very plausible business reasons for them to do so. Share these business reasons to add weight loss surgery to your company's insurance plan with your HR folks.

Keep in mind that if your insurance doesn't cover weight loss surgery (or for whatever portion it doesn't cover like coinsurance or deductibles), there are several financing options to make it more affordable, including:

1. Payment Plan Through a Qualified Bariatric Surgeon - This is probably your most realistic and affordable local non-insurance option - contact a local qualified weight loss surgeon to learn your options.
2. Friends & Family
3. Secured Medical Loans
4. Retirement Plan Loans
5. Permanent Life Insurance Loans
6. Brokers, Direct Lenders and Credit Cards (Unsecured Medical Loans)
7. Medical travel: a worthy consideration

Click here to learn more about each of these bariatric surgery financing options.

I hope that helps!

Jeff

Get Your Policy NEW
by: Lap Band Groupie

Jeff covered it all, but I just wanted to say that you can get your insurance policy info. from your company (usually HR) or from the insurance co. directly (many times they can tell you how to print it online). Ask for the 'Bariatric Policy/Rider". Read it carefully and follow it to the letter. Make sure your BMI is over 35 before you go for your first visit to the Doc (and hypertension is one of the comorbidities that counts if you're on medication for it…the rest of the things you mentioned don't count…diabetes only counts again, only if you have an official diagnosis on record). Best wishes!

Lap Band Groupie

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