Weight Loss Surgery - Insurance Checker & Cost Tools

Bariatric surgery insurance is provided by most insurance companies in the United States, but whether or not you’re covered will depend on your specific policy.

CHECK MY INSURANCE TOOL

Can’t find your insurance company/plan or have updated info? Click here to contact us.
Disclaimer: Accuracy not guaranteed. Contact your insurance company to confirm all benefits.
Advertisement

By Plan Type & State
Individual/Family, Small Group, Large Group, & Medicare/Medicaid

By Plan Type & State – Individual/Family, Small Group, Large Group, & Medicare/Medicaid

Before searching for your insurance company’s specific coverage requirements for weight loss surgery, you need to know whether your specific policy covers it. Review the following depending on your plan type to find out…

Individual or Family Insurance

Individual or Family Bariatric Surgery Coverage

Due to the passage of the Affordable Care Act (Obamacare), insurance companies in 23 states are REQUIRED to cover weight loss surgery for all Individual Plans, Family Plans and Small Group Plans (employers with fewer than 50 full-time employees). See the adjacent box for an updated list of Affordable Care Act weight loss surgery states.

Obamacare Weight Loss Surgery States (for Individual, Family & Small Group Plans)

  • Arizona
  • California
  • Delaware
  • Hawaii
  • Illinois
  • Iowa
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Oklahoma
  • Rhode Island
  • South Dakota
  • Vermont
  • West Virginia
  • Wyoming

To confirm your coverage, you have a couple of options:

  • Option 1 (recommended): Your local surgeon will contact your insurance company to confirm your benefits for free (even if you don’t move forward with surgery). Their office will be very familiar with your insurance company’s requirements and approval process, so it’s usually a good idea to let them do the leg work for you. Click here to find a local surgeon.
  • Option 2: Contact your insurance company yourself and/or check your Summary Plan Description (SPD). Click here for the full list of United States insurance companies, contact information and bariatric surgery coverage requirements.

If you find out that weight loss surgery is not covered, you still have several options for financing bariatric surgery to make treatment more affordable and to potentially reduce your out of pocket expenses.

For more information about Bariatric Surgery and the Affordable Care Act, see our Obamacare Weight Loss Surgery Page.

Through Work: Small Group (50 or fewer full-time employees)

Small Group Bariatric Surgery Insurance Coverage (2 to 50 full-time employees)

Weight loss surgery insurance coverage guidelines for Small Group (50 or fewer full time employees) are the same as for Individual/Family Plans. Click here to jump up to that section.

To confirm your Small Group bariatric surgery insurance coverage, you have a three options:

  • Option 1 (recommended): Your local surgeon will contact your insurance company to determine your coverage details for no charge (even if you decide not to have surgery). Their office has been through the approval process with your insurance company many times, so let them work on your behalf to make the process go as smoothly as possible. Click here to find a local surgeon.
  • Option 2: Ask your Human Resources (HR) Department whether or not weight loss surgery is an included benefit under your plan.
  • Option 3: Contact your insurance company yourself and/or check your Summary Plan Description (SPD). Click here for the full list of United States insurance companies, contact information and bariatric surgery coverage criteria.

If you have short term disability insurance through your employer, also see our section on Disability Insurance. You may be able to receive portion of your monthly salary while you’re having and recovering from surgery.

Through Work: Large Group (More than 50 full-time employees)

Large Group Weight Loss Surgery Insurance Coverage (51+ full-time employees)

If you get your insurance through your work and your employer has 51 or more full time employees, it is completely up to your company to decide whether or not to cover weight loss surgery.

To confirm your coverage, you have a three options:

  • Option 1 (recommended): Your local surgeon will contact your insurance company to confirm your benefits for free. Their office will be very familiar with your insurance company’s requirements and approval process, so it’s usually a good idea to let them do the leg work for you. Click here to find a local surgeon.
  • Option 2: Ask your Human Resources (HR) Department whether or not weight loss surgery is an included benefit under your plan.
  • Option 3: Contact your insurance company yourself and/or check your Summary Plan Description (SPD). Click here for the full list of United States insurance companies, contact information and bariatric surgery coverage policy details.

If you find out that bariatric surgery insurance is NOT included under your plan, you may want to head over to our Weight Loss Surgery Insurance Secrets page to learn how you may be able to get your company to add the coverage.

If you have short term disability insurance through your employer, you may be able to receive portion of your monthly salary while you’re having and recovering from surgery. See our Short Term Disability section for more information.

Medicare/Medicaid

Medicare & Medicaid Bariatric Surgery Insurance Coverage

Medicare and Medicaid BOTH cover bariatric surgery as long as you meet their qualification guidelines:

Medicaid Coverage & Bariatric Surgeons

Many surgeons do not accept Medicaid due to lower reimbursement levels (they are unable to cover their costs with the lower fees that Medicaid is allowed to pay).

Contact your local surgeon to confirm whether or not they will accept your Medicaid insurance. If they don’t, ask for a referral to a surgeon who does.

  1. A body mass index (BMI) over 35
  2. At least one co-morbidity (health problem) related to obesity
  3. Must have documentation in your medical records confirming that previous attempts at medical treatment for obesity have been unsuccessful

If you meet each of the above criteria, Medicare and Medicaid will cover the following procedures:

To get approved, you’ll need to be referred by your primary care physician or other attending doctor (probably not just a self-referral to a bariatric surgeon). Your surgeon will also need to be in The Centers for Medicare and Medicaid Services (CMS) directory.

If you have Medicare Advantage, you’ll need to verify that your chosen surgical team and their hospital are in your insurance company’s network. Contact your insurance company directly to find out (click here for a full list of insurance companies and contact info).

See our Medicaid/Medicare Bariatric Surgery page for more information.

By Insurance Company
A to Z List of Insurance Companies & Weight Loss Surgery Coverage Info

By Insurance Company – A to Z List of Insurance Companies & Weight Loss Surgery Coverage Info

The table below lists ALL health insurance companies in the United States that we know about along with the following:

  • Link to local surgeon directory: Most surgeons will contact your insurance company for you for free to confirm your bariatric surgery insurance coverage (they’ll usually do this regardless of whether you’ve decided to move forward with surgery). Their office will likely be very experienced in dealing with the complicated nuances of getting surgery approved by your insurance company, so we highly recommend working through them instead of trying to figure things out on your own. Click here to contact a local surgeon to get the process started.
  • Link to weight loss surgery insurance coverage policy: the presence (or lack of) a link to your insurance company’s policy does NOT confirm whether or not you have coverage. To figure out if your plan includes bariatric surgery insurance, see the Coverage by Plan Type and State section above.
  • Link to insurance company contact info: We’ve found your insurance company’s contact info for you so you don’t have to go digging for it.

Click the letter that your insurance company’s name begins with or use the table’s scroll bar on the right…

Insurance Company
Insurance Company
A – Bariatric Surgery Insurance Coverage Criteria by Company
A – Bariatric Surgery Insurance Coverage Criteria by Company
1199SEIU
1199SEIU
Aetna
Aetna
Altius
Altius
American Medical Security
American Medical Security
AmeriHealth
AmeriHealth
Anthem Blue Cross and/or Blue Shield
Anthem Blue Cross and/or Blue Shield
Arches Health Plan
Arches Health Plan
Arise Health Plan
Arise Health Plan
Asuris Northwest Health
Asuris Northwest Health
B – Bariatric Surgery Insurance Coverage Criteria by Company
B – Bariatric Surgery Insurance Coverage Criteria by Company
Blue Cross and/or Blue Shield (Alabama)
Blue Cross and/or Blue Shield (Alabama)
Blue Cross and/or Blue Shield (Arizona)
Blue Cross and/or Blue Shield (Arizona)
Blue Cross and/or Blue Shield (Arkansas)
Blue Cross and/or Blue Shield (Arkansas)
Blue Cross and/or Blue Shield (California)
Blue Cross and/or Blue Shield (California)
Blue Cross and/or Blue Shield (Florida)
Blue Cross and/or Blue Shield (Florida)
Blue Cross and/or Blue Shield (Georgia)
Blue Cross and/or Blue Shield (Georgia)
Blue Cross and/or Blue Shield (Hawaii)
Blue Cross and/or Blue Shield (Hawaii)
Blue Cross and/or Blue Shield (Idaho)
Blue Cross and/or Blue Shield (Idaho)
Blue Cross and/or Blue Shield (Illinois)
Blue Cross and/or Blue Shield (Illinois)
Blue Cross and/or Blue Shield (Kansas City)
Blue Cross and/or Blue Shield (Kansas City)
Blue Cross and/or Blue Shield (Kansas)
Blue Cross and/or Blue Shield (Kansas)
Blue Cross and/or Blue Shield (Louisiana HMO)
Blue Cross and/or Blue Shield (Louisiana HMO)
Blue Cross and/or Blue Shield (Louisiana NON-HMO)
Blue Cross and/or Blue Shield (Louisiana NON-HMO)
Blue Cross and/or Blue Shield (Massachusetts)
Blue Cross and/or Blue Shield (Massachusetts)
Blue Cross and/or Blue Shield (Michigan)
Blue Cross and/or Blue Shield (Michigan)
Blue Cross and/or Blue Shield (Minnesota)
Blue Cross and/or Blue Shield (Minnesota)
Blue Cross and/or Blue Shield (Mississippi)
Blue Cross and/or Blue Shield (Mississippi)
Blue Cross and/or Blue Shield (Montana)
Blue Cross and/or Blue Shield (Montana)
Blue Cross and/or Blue Shield (Nebraska)
Blue Cross and/or Blue Shield (Nebraska)
Blue Cross and/or Blue Shield (New Mexico)
Blue Cross and/or Blue Shield (New Mexico)
Blue Cross and/or Blue Shield (New York – Northeastern)
Blue Cross and/or Blue Shield (New York – Northeastern)
Blue Cross and/or Blue Shield (New York – Western)
Blue Cross and/or Blue Shield (New York – Western)
Blue Cross and/or Blue Shield (North Carolina)
Blue Cross and/or Blue Shield (North Carolina)
Blue Cross and/or Blue Shield (North Dakota)
Blue Cross and/or Blue Shield (North Dakota)
Blue Cross and/or Blue Shield (Oklahoma)
Blue Cross and/or Blue Shield (Oklahoma)
Blue Cross and/or Blue Shield (Pennsylvania-Northeastern / Wilkes-Barre)
Blue Cross and/or Blue Shield (Pennsylvania-Northeastern / Wilkes-Barre)
Blue Cross and/or Blue Shield (Rhode Island)
Blue Cross and/or Blue Shield (Rhode Island)
Blue Cross and/or Blue Shield (South Carolina)
Blue Cross and/or Blue Shield (South Carolina)
Blue Cross and/or Blue Shield (Tennessee)
Blue Cross and/or Blue Shield (Tennessee)
Blue Cross and/or Blue Shield (Texas)
Blue Cross and/or Blue Shield (Texas)
Blue Cross and/or Blue Shield (Vermont)
Blue Cross and/or Blue Shield (Vermont)
Blue Cross and/or Blue Shield (Wyoming)
Blue Cross and/or Blue Shield (Wyoming)
Blue Cross and/or Blue Shield Federal Employee Plan
Blue Cross and/or Blue Shield Federal Employee Plan
BridgeSpan Health
BridgeSpan Health
C – Bariatric Surgery Insurance Coverage Criteria by Company
C – Bariatric Surgery Insurance Coverage Criteria by Company
Capital BlueCross – Harrisburg
Capital BlueCross – Harrisburg
CareFirst Blue Cross Blue Shield
CareFirst Blue Cross Blue Shield
CHAMPVA
CHAMPVA
Cigna
Cigna
ConnectiCare
ConnectiCare
CoOportunity Health
CoOportunity Health
Coventry Health Care
Coventry Health Care
CoventryOne
CoventryOne
D – Bariatric Surgery Insurance Coverage Criteria by Company
D – Bariatric Surgery Insurance Coverage Criteria by Company
Dean Health
Dean Health
Definity Health
Definity Health
E – Bariatric Surgery Insurance Coverage Criteria by Company
E – Bariatric Surgery Insurance Coverage Criteria by Company
Emblem Health
Emblem Health
Empire Blue Cross and Blue Shield
Empire Blue Cross and Blue Shield
Excellus BlueCross BlueShield
Excellus BlueCross BlueShield
F – Bariatric Surgery Insurance Coverage Criteria by Company
F – Bariatric Surgery Insurance Coverage Criteria by Company
Fallon Health
Fallon Health
First Health
First Health
G – Bariatric Surgery Insurance Coverage Criteria by Company
G – Bariatric Surgery Insurance Coverage Criteria by Company
Geisinger Health Plan
Geisinger Health Plan
Golden Rule
Golden Rule
Group Health
Group Health
H – Bariatric Surgery Insurance Coverage Criteria by Company
H – Bariatric Surgery Insurance Coverage Criteria by Company
HAP (Health Alliance Plan)
HAP (Health Alliance Plan)
HCSC
HCSC
Health Net
Health Net
Health Plan of Nevada
Health Plan of Nevada
Health Republic Insurance of New Jersey
Health Republic Insurance of New Jersey
HealthAmerica
HealthAmerica
HealthPartners
HealthPartners
HealthPlus
HealthPlus
HealthSpan
HealthSpan
Highmark Blue Cross and/or Blue Shield
Highmark Blue Cross and/or Blue Shield
HIP Health Plan of New York
HIP Health Plan of New York
HMSA (Hawaii Medical Service Association)
HMSA (Hawaii Medical Service Association)
Horizon Blue Cross and Blue Shield
Horizon Blue Cross and Blue Shield
Humana
Humana
I – Bariatric Surgery Insurance Coverage Criteria by Company
I – Bariatric Surgery Insurance Coverage Criteria by Company
Independence Blue Cross – Philadelphia
Independence Blue Cross – Philadelphia
Innovation Health
Innovation Health
K – Bariatric Surgery Insurance Coverage Criteria by Company
K – Bariatric Surgery Insurance Coverage Criteria by Company
Kaiser
Kaiser
L – Bariatric Surgery Insurance Coverage Criteria by Company
L – Bariatric Surgery Insurance Coverage Criteria by Company
LifeWise Health Plan of Oregon
LifeWise Health Plan of Oregon
LifeWise Health Plan of Washington
LifeWise Health Plan of Washington
M – Bariatric Surgery Insurance Coverage Criteria by Company
M – Bariatric Surgery Insurance Coverage Criteria by Company
Medica
Medica
Medicare / Medicaid
Medicare / Medicaid
Medical Mutual of Ohio
Medical Mutual of Ohio
Meritus
Meritus
Moda Health
Moda Health
MVP Health Care
MVP Health Care
My Health Alliance
My Health Alliance
N – Bariatric Surgery Insurance Coverage Criteria by Company
N – Bariatric Surgery Insurance Coverage Criteria by Company
New Mexico Health Connections
New Mexico Health Connections
O – Bariatric Surgery Insurance Coverage Criteria by Company
O – Bariatric Surgery Insurance Coverage Criteria by Company
Office of Group Benefits (OGB) PPO
Office of Group Benefits (OGB) PPO
Optima Health
Optima Health
Oscar
Oscar
Oxford Health
Oxford Health
P – Bariatric Surgery Insurance Coverage Criteria by Company
P – Bariatric Surgery Insurance Coverage Criteria by Company
PacificSource Health Plans
PacificSource Health Plans
Physicians Health Plan (PHP)
Physicians Health Plan (PHP)
Physicians Plus
Physicians Plus
PreferredOne
PreferredOne
Premera Blue Cross
Premera Blue Cross
Presbyterian
Presbyterian
Prevea360 Health Plan
Prevea360 Health Plan
PriorityHealth
PriorityHealth
Providence Health Plan
Providence Health Plan
Q – Bariatric Surgery Insurance Coverage Criteria by Company
Q – Bariatric Surgery Insurance Coverage Criteria by Company
QualChoice – Federal Employees Health Benefits
QualChoice – Federal Employees Health Benefits
QualChoice – White County Medical Center
QualChoice – White County Medical Center
R – Bariatric Surgery Insurance Coverage Criteria by Company
R – Bariatric Surgery Insurance Coverage Criteria by Company
Regence Blue Cross and/or Blue Shield
Regence Blue Cross and/or Blue Shield
Rocky Mountain Health Plans
Rocky Mountain Health Plans
S – Bariatric Surgery Insurance Coverage Criteria by Company
S – Bariatric Surgery Insurance Coverage Criteria by Company
Scott & White Health Plan
Scott & White Health Plan
Security Health Plan
Security Health Plan
SelectHealth
SelectHealth
Sierra Health and Life
Sierra Health and Life
SummaCare
SummaCare
T – Bariatric Surgery Insurance Coverage Criteria by Company
T – Bariatric Surgery Insurance Coverage Criteria by Company
TennCare
TennCare
TriCare
TriCare
Tufts Health Plan
Tufts Health Plan
U – Bariatric Surgery Insurance Coverage Criteria by Company
U – Bariatric Surgery Insurance Coverage Criteria by Company
Unicare
Unicare
UnitedHealthOne
UnitedHealthOne
United Healthcare
United Healthcare
W – Bariatric Surgery Insurance Coverage Criteria by Company
W – Bariatric Surgery Insurance Coverage Criteria by Company
Wellmark Blue Cross and Blue Shield
Wellmark Blue Cross and Blue Shield
WINhealth
WINhealth
WPS Health Insurance
WPS Health Insurance
Insurance Company
Bariatric Surgery Insurance Coverage Policy
A – Bariatric Surgery Insurance Coverage Criteria by Company
1199SEIU
No weight loss surgery coverage criteria available
Altius
No weight loss surgery coverage criteria available
American Medical Security
No weight loss surgery coverage criteria available
Arches Health Plan
No weight loss surgery coverage criteria available
Arise Health Plan
No weight loss surgery coverage criteria available
B – Bariatric Surgery Insurance Coverage Criteria by Company
Blue Cross and/or Blue Shield (Kansas)
No weight loss surgery coverage criteria available
Blue Cross and/or Blue Shield (Louisiana NON-HMO)
No weight loss surgery coverage criteria available
C – Bariatric Surgery Insurance Coverage Criteria by Company
Coventry Health Care
No weight loss surgery coverage criteria available
CoventryOne
No weight loss surgery coverage criteria available
D – Bariatric Surgery Insurance Coverage Criteria by Company
Definity Health
No weight loss surgery coverage criteria available
E – Bariatric Surgery Insurance Coverage Criteria by Company
F – Bariatric Surgery Insurance Coverage Criteria by Company
First Health
No weight loss surgery coverage criteria available
G – Bariatric Surgery Insurance Coverage Criteria by Company
H – Bariatric Surgery Insurance Coverage Criteria by Company
HAP (Health Alliance Plan)
No weight loss surgery coverage criteria available
HealthAmerica
No weight loss surgery coverage criteria available
HealthSpan
No weight loss surgery coverage criteria available
I – Bariatric Surgery Insurance Coverage Criteria by Company
K – Bariatric Surgery Insurance Coverage Criteria by Company
L – Bariatric Surgery Insurance Coverage Criteria by Company
M – Bariatric Surgery Insurance Coverage Criteria by Company
N – Bariatric Surgery Insurance Coverage Criteria by Company
New Mexico Health Connections
No weight loss surgery coverage criteria available
O – Bariatric Surgery Insurance Coverage Criteria by Company
Oscar
No weight loss surgery coverage criteria available
P – Bariatric Surgery Insurance Coverage Criteria by Company
PacificSource Health Plans
No weight loss surgery coverage criteria available
Physicians Health Plan (PHP)
No weight loss surgery coverage criteria available
Prevea360 Health Plan
No weight loss surgery coverage criteria available
Q – Bariatric Surgery Insurance Coverage Criteria by Company
R – Bariatric Surgery Insurance Coverage Criteria by Company
S – Bariatric Surgery Insurance Coverage Criteria by Company
Security Health Plan
No weight loss surgery coverage criteria available
SelectHealth
No weight loss surgery coverage criteria available
SummaCare
No weight loss surgery coverage criteria available
T – Bariatric Surgery Insurance Coverage Criteria by Company
TennCare
No weight loss surgery coverage criteria available
U – Bariatric Surgery Insurance Coverage Criteria by Company
W – Bariatric Surgery Insurance Coverage Criteria by Company
WPS Health Insurance
No weight loss surgery coverage criteria available
Insurance Company
Find Local Surgeon (Will Check Insurance for Free)
A – Bariatric Surgery Insurance Coverage Criteria by Company
B – Bariatric Surgery Insurance Coverage Criteria by Company
Blue Cross and/or Blue Shield (New York – Northeastern)
Blue Cross and/or Blue Shield (Pennsylvania-Northeastern / Wilkes-Barre)
C – Bariatric Surgery Insurance Coverage Criteria by Company
D – Bariatric Surgery Insurance Coverage Criteria by Company
E – Bariatric Surgery Insurance Coverage Criteria by Company
F – Bariatric Surgery Insurance Coverage Criteria by Company
G – Bariatric Surgery Insurance Coverage Criteria by Company
H – Bariatric Surgery Insurance Coverage Criteria by Company
I – Bariatric Surgery Insurance Coverage Criteria by Company
K – Bariatric Surgery Insurance Coverage Criteria by Company
L – Bariatric Surgery Insurance Coverage Criteria by Company
M – Bariatric Surgery Insurance Coverage Criteria by Company
N – Bariatric Surgery Insurance Coverage Criteria by Company
O – Bariatric Surgery Insurance Coverage Criteria by Company
P – Bariatric Surgery Insurance Coverage Criteria by Company
Q – Bariatric Surgery Insurance Coverage Criteria by Company
R – Bariatric Surgery Insurance Coverage Criteria by Company
S – Bariatric Surgery Insurance Coverage Criteria by Company
T – Bariatric Surgery Insurance Coverage Criteria by Company
U – Bariatric Surgery Insurance Coverage Criteria by Company
W – Bariatric Surgery Insurance Coverage Criteria by Company
Insurance Company
Insurance Company Contact Info
A – Bariatric Surgery Insurance Coverage Criteria by Company
American Medical Security
Anthem Blue Cross and/or Blue Shield
B – Bariatric Surgery Insurance Coverage Criteria by Company
Blue Cross and/or Blue Shield (Alabama)
Blue Cross and/or Blue Shield (Arizona)
Blue Cross and/or Blue Shield (Arkansas)
Blue Cross and/or Blue Shield (California)
Blue Cross and/or Blue Shield (Florida)
Blue Cross and/or Blue Shield (Georgia)
Blue Cross and/or Blue Shield (Hawaii)
Blue Cross and/or Blue Shield (Idaho)
Blue Cross and/or Blue Shield (Illinois)
Blue Cross and/or Blue Shield (Kansas City)
Blue Cross and/or Blue Shield (Kansas)
Blue Cross and/or Blue Shield (Louisiana HMO)
Blue Cross and/or Blue Shield (Louisiana NON-HMO)
Blue Cross and/or Blue Shield (Massachusetts)
Blue Cross and/or Blue Shield (Michigan)
Blue Cross and/or Blue Shield (Minnesota)
Blue Cross and/or Blue Shield (Mississippi)
Blue Cross and/or Blue Shield (Montana)
Blue Cross and/or Blue Shield (Nebraska)
Blue Cross and/or Blue Shield (New Mexico)
Blue Cross and/or Blue Shield (New York – Northeastern)
Blue Cross and/or Blue Shield (New York – Western)
Blue Cross and/or Blue Shield (North Carolina)
Blue Cross and/or Blue Shield (North Dakota)
Blue Cross and/or Blue Shield (Oklahoma)
Blue Cross and/or Blue Shield (Pennsylvania-Northeastern / Wilkes-Barre)
Blue Cross and/or Blue Shield (Rhode Island)
Blue Cross and/or Blue Shield (South Carolina)
Blue Cross and/or Blue Shield (Tennessee)
Blue Cross and/or Blue Shield (Texas)
Blue Cross and/or Blue Shield (Vermont)
Blue Cross and/or Blue Shield (Wyoming)
Blue Cross and/or Blue Shield Federal Employee Plan
C – Bariatric Surgery Insurance Coverage Criteria by Company
Capital BlueCross – Harrisburg
CareFirst Blue Cross Blue Shield
D – Bariatric Surgery Insurance Coverage Criteria by Company
E – Bariatric Surgery Insurance Coverage Criteria by Company
Empire Blue Cross and Blue Shield
Excellus BlueCross BlueShield
F – Bariatric Surgery Insurance Coverage Criteria by Company
G – Bariatric Surgery Insurance Coverage Criteria by Company
H – Bariatric Surgery Insurance Coverage Criteria by Company
HAP (Health Alliance Plan)
Health Republic Insurance of New Jersey
Highmark Blue Cross and/or Blue Shield
HIP Health Plan of New York
HMSA (Hawaii Medical Service Association)
Horizon Blue Cross and Blue Shield
I – Bariatric Surgery Insurance Coverage Criteria by Company
Independence Blue Cross – Philadelphia
K – Bariatric Surgery Insurance Coverage Criteria by Company
L – Bariatric Surgery Insurance Coverage Criteria by Company
LifeWise Health Plan of Oregon
LifeWise Health Plan of Washington
M – Bariatric Surgery Insurance Coverage Criteria by Company
N – Bariatric Surgery Insurance Coverage Criteria by Company
New Mexico Health Connections
O – Bariatric Surgery Insurance Coverage Criteria by Company
Office of Group Benefits (OGB) PPO
P – Bariatric Surgery Insurance Coverage Criteria by Company
PacificSource Health Plans
Physicians Health Plan (PHP)
Q – Bariatric Surgery Insurance Coverage Criteria by Company
QualChoice – Federal Employees Health Benefits
QualChoice – White County Medical Center
R – Bariatric Surgery Insurance Coverage Criteria by Company
Regence Blue Cross and/or Blue Shield
Rocky Mountain Health Plans
S – Bariatric Surgery Insurance Coverage Criteria by Company
Scott & White Health Plan
T – Bariatric Surgery Insurance Coverage Criteria by Company
U – Bariatric Surgery Insurance Coverage Criteria by Company
W – Bariatric Surgery Insurance Coverage Criteria by Company
Wellmark Blue Cross and Blue Shield

Can’t find your insurance company/plan or have an updated link? Click here to contact us.

By Procedure
Sleeve, Bypass, DS, & Band Are Covered Under Most Bariatric Policies

By Procedure – Sleeve, Bypass, DS, & Band Are Covered Under Most Bariatric Policies

Most health plans that provide bariatric surgery insurance will pay for the following procedures (assuming you meet their coverage criteria):

Some also cover the following in certain circumstances:

Most insurance companies will NOT cover:

  • Gastric balloon
  • vBloc Therapy
  • Experimental procedures

Click here to compare all types of bariatric surgery.

Approval Process
Get Insurance to Pay in 8 Steps

Approval Process – Get Insurance to Pay in 8 Steps

If your plan includes bariatric surgery insurance, you will need to meet all of your insurance company’s coverage criteria (click here for list of insurance companies) to confirm the "medical necessity" of your surgery.

Assuming you follow all the guidelines and provide complete, accurate information requested by your insurance company, the process from start to finish can take anywhere from one month to one year.

To prove to your insurance company that your surgery is medically necessary, following are the typical steps:

  1. Minimum body mass index (BMI) requirements to be confirmed by your physician:
    • BMI over 40 –OR–
    • BMI over 35 with one or more of the following:
      • Clinically significant obstructive sleep apnea
      • Coronary heart disease
      • Medically refractory hypertension
      • Type 2 diabetes mellitus
  2. Complete a medically supervised diet program. Bariatric surgery insurance criteria for the length of the program range from 3 to 7 consecutive months.
  3. Schedule a consultation with your bariatric surgeon.
  4. Schedule a consultation with your primary care physician to obtain a medical clearance letter.
  5. Schedule a psychiatric evaluation to obtain a mental health clearance letter.
  6. Schedule a nutritional evaluation from a Registered Dietitian.
  7. Send all of the above documentation to your insurance company along with a detailed history of your obesity-related health problems, difficulties and treatment attempts. The review process typically happens in under one month.
  8. Insurance company sends approval or denial letter:
    • If approved, your surgeon’s bariatric coordinator will contact you for scheduling.
    • If denied, you can choose to appeal the denial.

Your surgeon’s office will be very experienced in managing the above process and may have all of the required personnel on staff (e.g. registered dietitian, psychiatrist, bariatric coordinator, etc.).

Click here to access the weight loss surgeon directory to get started. Most offices will check your insurance for free to confirm coverage criteria.

Find a Top Weight Loss Surgeon

Search By Location

SEARCH BY REGION

Advertisement

Bariatric Surgery Insurance References

  1. Vanek VW. State laws on insurance coverage for bariatric
    surgery: help or a hindrance? American Society for Bariatric Surgery.
    May 2005. doi:10.1016/j.soard.2005.05.001.

[ Last editorial review/modification of this page : 07/31/2016]

* Disclaimer: The information contained in this website is provided for general information purposes and your specific results may vary depending on a variety of circumstances. It is not intended as nor should be relied upon as medical advice. Rather, it is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician(s). Before you use any of the information provided in the site, you should seek the advice of a qualified medical, dietary, fitness or other appropriate professional. Read More