Bariatric Surgery Insurance - How to Get It Covered

Bariatric Surgery Insurance coverage varies by insurance policy. If your policy covers weight loss surgery and you meet the qualification requirements, most plans will pay for you to have gastric sleeve, gastric bypass, Lap-Band, or duodenal switch surgery. Your out-of-pocket costs for these procedures will be about $3,500.

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This tool provides estimates only. Please contact your insurance company to verify your actual out of pocket costs.

Read and click below for additional weight loss surgery insurance details.

TABLE OF CONTENTS

  1. Insurance Coverage by Plan Type & State
  2. Covered Weight Loss Procedures
  3. How to Get Approved
  4. Find a Top Surgeon
1.

Insurance Coverage by Plan Type & State

  • Individual/family coverage

  • Small employer coverage (Under 50 employees)

  • Large employer coverage (50+ employees)

  • Medicare & Medicaid coverage

Lap Band Insurance

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

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). See our page on Insurance That Covers Bariatric Surgery 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)

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)

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 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.

2.

Covered Weight Loss Procedures

  • Gastric sleeve, gastric bypass, duodenal switch, & Lap-Band are covered under most plans that include bariatric surgery

  • Other procedures are usually not covered by insurance but have discounts, tax savings, & financing available

Lap Band Insurance

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:

Click here to compare all types of bariatric surgery.

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3.

How to Get Approved

  • 8 steps to bariatric surgery insurance approval

Lap Band Insurance

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.

4.

Find a Top Weight Loss Surgeon

  • Ask for a free insurance check or cost quote

  • Attend a free seminar or webinar

  • Schedule a phone or in-person consultation (both often free)

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* Disclaimers: Content: 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. Advertising: Bariatric Surgery Source, LLC has entered into referral and advertising arrangements with certain medical practices, original equipment manufacturers, and financial companies under which we receive compensation (in the form of flat fees per qualifying action) when you click on links to our partners and/or submit information. Read More