Gastric Sleeve Insurance

Gastric Sleeve Insurance Coverage Requirements

The quick (and unsatisfying) answer is that gastric sleeve insurance coverage in the U.S. varies by insurance policy. Your insurance will cover gastric sleeve if your specific policy includes weight loss surgery and you satisfy the minimum requirements for coverage.

The minimum requirements for most medical insurance policies that cover bariatric surgery are that you have completed a medically supervised diet program and you a body mass index (BMI) over 35 with obesity-related health problems or over 40 without accompanying health problems.

Gastric sleeve surgery costs about $3,500 if your insurance covers it, depending on your policy. The cost of gastric sleeve surgery without insurance is $19,000, on average, but varies widely by state and surgeon.

Click Here to Check Your Insurance

Read below to learn everything you need to know about gastric sleeve insurance requirements.

https://www.tn.gov/tenncare/contact-us.html
Advertisement
01.

Insurance Coverage for Gastric Sleeve Surgery by Plan Type & State

SECTION SUMMARY:

  • Gastric sleeve is included under all insurance plans that cover weight loss surgery

Does insurance cover gastric sleeve surgery?

  • Yes, for individual policies, family policies, and small group policies located in Obamacare states
  • Yes, for large group policies that choose to include it
  • Yes, for Medicare and Medicaid
  • No, for individual policies, family policies, and small group policies that are not located in Obamacare states
  • No, for large group policies that choose to exclude it

Find your plan type below for more information.

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

To confirm your gastric sleeve insurance 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 gastric sleeve insurance 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 gastric sleeve 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 gastric sleeve insurance 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 gastric sleeve insurance 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 gastric sleeve insurance policy details.

If you find out that gastric sleeve 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.

02.

Gastric Sleeve Coverage by Insurance Company

SECTION SUMMARY:

  • A to Z list of insurance companies
  • Gastric sleeve insurance coverage info for each

Is gastric sleeve covered by your insurance policy? Yes, as long as bariatric surgery is a covered benefit under your plan.

The chart below includes the following information for every insurance company in the United States:

  • Link to local surgeon directory: Most surgeons will contact your insurance company for you for free to confirm your gastric sleeve 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 gastric sleeve 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 scroll through the table to find your insurance company…

Click the arrows to see more columns

Swipe Left/Right to View More Columns

Insurance Company Gastric Sleeve Insurance Coverage Policy Find Local Surgeon (Will Check Insurance for Free) Insurance Company Contact Info
1199SEIU No weight loss surgery coverage criteria available Ask Local Surgeon to Check Your 1199SEIU Benefits for Free Contact 1199SEIU Directly
Aetna Aetna Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Aetna Benefits for Free Contact Aetna Directly
Altius No weight loss surgery coverage criteria available Ask Local Surgeon to Check Your Altius Benefits for Free Contact Altius Directly
American Medical Security No weight loss surgery coverage criteria available Ask Local Surgeon to Check Your American Medical Security Benefits for Free Contact American Medical Security Directly
AmeriHealth AmeriHealth Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your AmeriHealth Benefits for Free Contact AmeriHealth Directly
Anthem Blue Cross and/or Blue Shield Anthem Blue Cross Blue Shield Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Anthem BCBS Benefits for Free Contact Anthem BCBS Directly
Arches Health Plan No weight loss surgery coverage criteria available Ask Local Surgeon to Check Your Arches Health Plan Benefits for Free Contact Arches Health Plan Directly
Arise Health Plan No weight loss surgery coverage criteria available Ask Local Surgeon to Check Your Arise Health Plan Benefits for Free Contact Arise Health Plan Directly
Asuris Northwest Health Asuris Northwest Health Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Asuris Northwest Health Benefits for Free Contact Asuris Northwest Health Directly
Blue Cross and/or Blue Shield (Alabama) Blue Cross Blue Shield Alabama Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Blue Cross Blue Shield (Alabama) Benefits for Free Ask Local Surgeon to Check Your Blue Cross Blue Shield (Alabama) Benefits for Free
Blue Cross and/or Blue Shield (Alabama) Blue Cross Blue Shield Arizona Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Blue Cross and/or Blue Shield (Arizona) Benefits for Free Ask Local Surgeon to Check Your Blue Cross and/or Blue Shield (Arizona) Benefits for Free
Blue Cross and/or Blue Shield (Arkansas) Blue Cross Blue Shield Arkansas Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Blue Cross Blue Shield Arkansas Benefits for Free Contact Blue Cross and/or Blue Shield (Arkansas) Directly
Blue Cross and/or Blue Shield (California) Blue Shield California Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Blue Shield California Benefits for Free Contact Blue Shield (California) Directly
Blue Cross and/or Blue Shield (Florida) Blue Cross Blue Shield Florida Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Blue Cross Blue Shield Florida Benefits for Free Contact Blue Cross and/or Blue Shield (Florida) Directly
Blue Cross and/or Blue Shield (Georgia) Blue Cross Blue Shield Georgia Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Blue Cross Blue Shield Georgia Benefits for Free Contact Blue Cross and/or Blue Shield (Georgia) Directly
Blue Cross and/or Blue Shield (Hawaii) Blue Cross and/or Blue Shield (Hawaii) Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Blue Cross and/or Blue Shield (Hawaii) Benefits for Free Contact Blue Cross and/or Blue Shield (Hawaii) Directly
Blue Cross and/or Blue Shield (Idaho) Blue Cross and/or Blue Shield (Idaho) Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Blue Cross and/or Blue Shield (Idaho) Benefits for Free Contact Blue Cross and/or Blue Shield (Idaho) Directly
Blue Cross and/or Blue Shield (Illinois) Blue Cross Blue Shield Illinois Weight Loss Surgery Coverage Criteria Blue Cross Blue Shield Illinois Weight Loss Surgery Coverage Criteria Contact Blue Cross Blue Shield Illinois Directly
Blue Cross and/or Blue Shield (Kansas City) Blue Cross Blue Shield Kansas City Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Blue Cross Blue Shield Kansas City Benefits for Free Contact Blue Cross Blue Shield Kansas City Directly
Blue Cross and/or Blue Shield (Kansas) No weight loss surgery coverage criteria available Ask Local Surgeon to Check Your Blue Cross and/or Blue Shield (Kansas) Benefits for Free Contact Blue Cross and/or Blue Shield (Kansas) Directly
Blue Cross and/or Blue Shield (Louisiana HMO) Blue Cross Louisiana HMO gastric sleeve insurance coverage requirements Ask Local Surgeon to Check Your Blue Cross and/or Blue Shield (Louisiana HMO) Benefits for Free Contact Blue Cross Louisiana HMO Directly
Blue Cross and/or Blue Shield (Louisiana NON-HMO) No weight loss surgery coverage criteria available Ask Local Surgeon to Check Your Blue Cross and/or Blue Shield (Louisiana) Benefits for Free Contact Blue Cross and/or Blue Shield (Louisiana) Directly
Blue Cross and/or Blue Shield (Massachusetts) Blue Cross and/or Blue Shield Massachusetts Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Blue Cross Blue Shield Massachusetts Benefits for Free Contact Blue Cross Blue Shield Massachusetts Directly
Blue Cross and/or Blue Shield (Michigan) Blue Cross Blue Shield Michigan Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Blue Cross Blue Shield Michigan Benefits for Free Contact Blue Cross Blue Shield Michigan Directly
Blue Cross and/or Blue Shield (Minnesota) Blue Cross and/or Blue Shield (Minnesota) Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Blue Cross and/or Blue Shield (Minnesota) Benefits for Free Contact Blue Cross and/or Blue Shield (Minnesota) Directly
Blue Cross and/or Blue Shield (Mississippi) Blue Cross and/or Blue Shield (Mississippi) Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Blue Cross and/or Blue Shield (Mississippi) Benefits for Free Contact Blue Cross and/or Blue Shield (Mississippi) Directly
Blue Cross and/or Blue Shield (Montana) Blue Cross and/or Blue Shield (Montana) Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Blue Cross and/or Blue Shield (Montana) Benefits for Free Contact Blue Cross and/or Blue Shield (Montana) Directly
Blue Cross and/or Blue Shield (Nebraska) Blue Cross and/or Blue Shield (Nebraska) Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Blue Cross and/or Blue Shield (Nebraska) Benefits for Free Contact Blue Cross and/or Blue Shield (Nebraska) Directly
Blue Cross and/or Blue Shield (New Mexico) Blue Cross and/or Blue Shield (New Mexico) Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Blue Cross and/or Blue Shield (New Mexico) Benefits for Free Contact Blue Cross and/or Blue Shield (New Mexico) Directly
Blue Cross and/or Blue Shield (New York – Northeastern) BlueShield of Northeastern New York Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your BlueShield of Northeastern New York Benefits for Free Contact BlueShield of Northeastern New York) Directly
Blue Cross and/or Blue Shield (New York – Western) BlueCross Blue Shield of Western New York Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your BlueCross Blue Shield of Western New York Benefits for Free Contact BlueCross Blue Shield of Western New York Directly
Blue Cross and/or Blue Shield (North Carolina) Blue Cross Blue Shield North Carolina Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Blue Cross Blue Shield North Carolina Benefits for Free Contact Blue Cross Blue Shield North Carolina Directly
Blue Cross and/or Blue Shield (North Dakota) Blue Cross and/or Blue Shield (North Dakota) Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Blue Cross and/or Blue Shield (North Dakota) Benefits for Free Contact Blue Cross and/or Blue Shield (North Dakota) Directly
Blue Cross and/or Blue Shield (Oklahoma) Blue Cross and/or Blue Shield (Oklahoma) Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Blue Cross and/or Blue Shield (Oklahoma) Benefits for Free Contact Blue Cross and/or Blue Shield (Oklahoma) Directly
Blue Cross and/or Blue Shield (Pennsylvania-Northeastern / Wilkes-Barre) Blue Cross of Northeastern Pennsylvania Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Blue Cross of Northeastern Pennsylvania Benefits for Free Contact Blue Cross of Northeastern Pennsylvania Directly
Blue Cross and/or Blue Shield (Rhode Island) Blue Cross and/or Blue Shield (Rhode Island) Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Blue Cross and/or Blue Shield (Rhode Island) Benefits for Free Contact Blue Cross and/or Blue Shield (Rhode Island) Directly
Blue Cross and/or Blue Shield (South Carolina) Blue Cross and/or Blue Shield (South Carolina) Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Blue Cross and/or Blue Shield (South Carolina) Benefits for Free Contact Blue Cross and/or Blue Shield (South Carolina) Directly
Blue Cross and/or Blue Shield (Tennessee) Blue Cross Blue Shield Tennessee Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Blue Cross Blue Shield Tennessee Benefits for Free Contact Blue Cross Blue Shield Tennessee Directly
Blue Cross and/or Blue Shield (Texas) Blue Cross Blue Shield Texas Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Blue Cross Blue Shield (Texas) Benefits for Free Contact Blue Cross Blue Shield (Texas) Directly
Blue Cross and/or Blue Shield (Vermont) Blue Cross and/or Blue Shield (Vermont) Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Blue Cross and/or Blue Shield (Vermont) Benefits for Free Contact Blue Cross and/or Blue Shield (Vermont) Directly
Blue Cross and/or Blue Shield (Wyoming) Blue Cross and/or Blue Shield (Wyoming) Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Blue Cross and/or Blue Shield (Wyoming) Benefits for Free Contact Blue Cross and/or Blue Shield (Wyoming) Directly
Blue Cross and/or Blue Shield Federal Employee Plan Blue Cross and/or Blue Shield Federal Employee Plan Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Blue Cross and/or Blue Shield Federal Employee Plan Benefits for Free Contact Blue Cross and/or Blue Shield Federal Employee Plan Directly
BridgeSpan Health BridgeSpan Health Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your BridgeSpan Health Benefits for Free Contact BridgeSpan Health Directly
Capital BlueCross – Harrisburg Capital BlueCross – Harrisburg Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your BridgeSpan Health Benefits for Free Contact Capital BlueCross – Harrisburg Directly
CareFirst Blue Cross Blue Shield CareFirst Blue Cross Blue Shield Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your CareFirst Blue Cross Blue Shield Benefits for Free Contact CareFirst Blue Cross Blue Shield Directly
CHAMPVA CHAMPVA Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your CHAMPVA Benefits for Free Contact CHAMPVA Directly
Cigna Cigna Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Cigna Benefits for Free Contact Cigna Directly
ConnectiCare ConnectiCare Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your ConnectiCare Benefits for Free Contact ConnectiCare Directly
CoOportunity Health CoOportunity Health Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your CoOportunity Health Benefits for Free Contact CoOportunity Health Directly
Coventry Health Care No weight loss surgery coverage criteria available Ask Local Surgeon to Check Your Coventry Health Care Benefits for Free Contact Coventry Health Care Directly
CoventryOne No weight loss surgery coverage criteria available Ask Local Surgeon to Check Your CoventryOne Benefits for Free Contact CoventryOne Directly
Dean Health Dean Health Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Dean Health Benefits for Free Contact Dean Health Directly
Definity Health No weight loss surgery coverage criteria available Ask Local Surgeon to Check Your Definity Health Benefits for Free Contact Definity Health Directly
Emblem Health Emblem Health Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Emblem Health Benefits for Free Contact Emblem Health Directly
Empire Blue Cross and Blue Shield Empire Blue Cross and Blue Shield Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Empire Blue Cross and Blue Shield Benefits for Free Contact Empire Blue Cross and Blue Shield Directly
Excellus BlueCross BlueShield Excellus BlueCross BlueShield Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Excellus BlueCross BlueShield Benefits for Free Contact Excellus BlueCross BlueShield Directly
Fallon Health Fallon Health Weight Loss Surgery Coverage Criteria (use InterQual guidelines) Ask Local Surgeon to Check Your Fallon Health Benefits for Free Contact Fallon Health Directly
First Health No weight loss surgery coverage criteria available Ask Local Surgeon to Check Your First Health Benefits for Free Contact First Health Directly
Geisinger Health Plan Geisinger Health Plan Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Geisinger Health Plan Benefits for Free Contact Geisinger Health Plan Directly
Golden Rule Golden Rule Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Golden Rule Benefits for Free Contact Golden Rule Directly
Group Health Group Health Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Group Health Benefits for Free Contact Group Health Directly
HAP (Health Alliance Plan) No weight loss surgery coverage criteria available Ask Local Surgeon to Check Your HAP (Health Alliance Plan) Benefits for Free Contact HAP (Health Alliance Plan) Directly
HCSC HCSC Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your HCSC Benefits for Free Contact HCSC Directly
Health Net Health Net Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Health Net Benefits for Free Contact Health Net Directly
Health Plan of Nevada Health Plan of Nevada Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Health Plan of Nevada Benefits for Free Contact Health Plan of Nevada Directly
Health Republic Insurance of New Jersey Health Republic Insurance of New Jersey Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Health Republic Insurance of New Jersey Benefits for Free Contact Health Republic Insurance of New Jersey Directly
HealthAmerica No weight loss surgery coverage criteria available Ask Local Surgeon to Check Your HealthAmerica Benefits for Free Contact HealthAmerica Directly
HealthPartners HealthPartners Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your HealthPartners Benefits for Free Contact HealthPartners Directly
HealthPlus HealthPlus Physician Guidelines for the Management of Obesity in Adults Ask Local Surgeon to Check Your HealthPlus Benefits for Free Contact HealthPlus Directly
HealthSpan No weight loss surgery coverage criteria available Ask Local Surgeon to Check Your HealthSpan Benefits for Free Contact HealthSpan Directly
Highmark Blue Cross and/or Blue Shield Highmark Blue Cross Blue Shield Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Highmark Blue Cross Blue Shield Benefits for Free Contact Highmark Blue Cross Blue Shield Directly
HIP Health Plan of New York HIP Health Plan of New York Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your HIP Health Plan of New York Benefits for Free Contact HIP Health Plan of New York Directly
HMSA (Hawaii Medical Service Association) HMSA (Hawaii Medical Service Association) Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your HMSA (Hawaii Medical Service Association) Benefits for Free Contact HMSA (Hawaii Medical Service Association) Directly
Horizon Blue Cross and Blue Shield Horizon Blue Cross and Blue Shield Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Horizon Blue Cross and Blue Shield Benefits for Free Contact Horizon Blue Cross and Blue Shield Directly
Humana Humana Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Humana Benefits for Free Contact Humana Directly
Independence Blue Cross – Philadelphia Independence Blue Cross – Philadelphia Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Independence Blue Cross – Philadelphia Benefits for Free Contact Independence Blue Cross – Philadelphia Directly
Innovation Health Innovation Health Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Innovation Health Benefits for Free Contact Innovation Health Directly
Kaiser Kaiser Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Kaiser Benefits for Free Contact Kaiser Directly
LifeWise Health Plan of Oregon LifeWise Health Plan of Oregon Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your LifeWise Health Plan of Oregon Benefits for Free Contact LifeWise Health Plan of Oregon Directly
LifeWise Health Plan of Washington LifeWise Health Plan of Washington Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your LifeWise Health Plan of Washington Benefits for Free Contact LifeWise Health Plan of Washington Directly
Medica Medica Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Medica Benefits for Free Contact Medica Directly
Medicare / Medicaid Medicare/Medicaid Weight Loss Surgery Coverage Requirements Ask Local Surgeon to Check Your Medicare or Medicaid Benefits for Free Contact the Centers for Medicare and Medicaid Services Directly
Medical Mutual of Ohio Medical Mutual of Ohio Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Medical Mutual of Ohio Benefits for Free Contact Medical Mutual of Ohio Directly
Meritus Meritus Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Meritus Benefits for Free Contact Meritus Directly
Moda Health Moda Health Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Moda Health Benefits for Free Contact Moda Health Directly
MVP Health Care MVP Health Care Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your MVP Health Care Benefits for Free Contact MVP Health Care Directly
My Health Alliance My Health Alliance Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your My Health Alliance Benefits for Free Contact My Health Alliance Directly
New Mexico Health Connections No weight loss surgery coverage criteria available Ask Local Surgeon to Check Your New Mexico Health Connections Benefits for Free Contact New Mexico Health Connections Directly
Office of Group Benefits (OGB) PPO Office of Group Benefits (OGB) Gastric Sleeve Insurance Coverage Requirements Ask Local Surgeon to Check Your Office of Group Benefits (OGB) PPO Benefits for Free Contact Office of Group Benefits (OGB) PPO Directly
Optima Health Optima Health Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Optima Health Benefits for Free Contact Optima Health Directly
Oscar No weight loss surgery coverage criteria available Ask Local Surgeon to Check Your Oscar Benefits for Free Contact Oscar Directly
Oxford Health Oxford Health Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Oxford Health Benefits for Free Contact Oxford Health Directly
PacificSource Health Plans No weight loss surgery coverage criteria available Ask Local Surgeon to Check Your PacificSource Health Plans Benefits for Free Contact PacificSource Health Plans Directly
Physicians Health Plan (PHP) No weight loss surgery coverage criteria available Ask Local Surgeon to Check Your Physicians Health Plan (PHP) Benefits for Free Contact Physicians Health Plan (PHP) Directly
Physicians Plus Physicians Plus Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Physicians Plus Benefits for Free Contact Physicians Plus Directly
PreferredOne PreferredOne Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your PreferredOne Benefits for Free Contact PreferredOne Directly
Premera Blue Cross Premera Blue Cross Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Premera Blue Cross Benefits for Free Contact Premera Blue Cross Directly
Presbyterian Presbyterian Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Presbyterian Benefits for Free Contact Presbyterian Directly
Prevea360 Health Plan No weight loss surgery coverage criteria available Ask Local Surgeon to Check Your Prevea360 Health Plan Benefits for Free Contact Prevea360 Health Plan Directly
PriorityHealth PriorityHealth Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your PriorityHealth Benefits for Free Contact PriorityHealth Directly
Providence Health Plan Providence Health Plan Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Providence Health Plan Benefits for Free Contact Providence Health Plan Directly
QualChoice – Federal Employees Health Benefits QualChoice – Federal Employees Health Benefits Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your QualChoice – Federal Employees Health Benefits Benefits for Free Contact QualChoice – Federal Employees Health Benefits Directly
QualChoice – White County Medical Center QualChoice – White County Medical Center Weight Loss Surgery Coverage Criteria QualChoice – White County Medical Center Weight Loss Surgery Coverage Criteria Contact QualChoice – White County Medical Center Directly
Regence Blue Cross and/or Blue Shield Regence Blue Cross and/or Blue Shield Weight Loss Surgery Coverage Criteria Regence Blue Cross and/or Blue Shield Weight Loss Surgery Coverage Criteria Contact Regence BlueCross and/or BlueShield Directly
Rocky Mountain Health Plans Rocky Mountain Health Plans Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Rocky Mountain Health Plans Benefits for Free Contact Rocky Mountain Health Plans Directly
Scott & White Health Plan Scott & White Health Plan Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Scott & White Health Plan Benefits for Free Contact Scott & White Health Plan Directly
Security Health Plan No weight loss surgery coverage criteria available Ask Local Surgeon to Check Your Security Health Plan Benefits for Free Contact Security Health Plan Directly
SelectHealth No weight loss surgery coverage criteria available Ask Local Surgeon to Check Your SelectHealth Benefits for Free Contact SelectHealth Directly
Sierra Health and Life Sierra Health and Life Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Sierra Health and Life Benefits for Free Contact Sierra Health and Life Directly
SummaCare No weight loss surgery coverage criteria available Ask Local Surgeon to Check Your SummaCare Benefits for Free Contact SummaCare Directly
TennCare No weight loss surgery coverage criteria available Ask Local Surgeon to Check Your TennCare Benefits for Free Contact TennCare Directly
TriCare TriCare Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your TriCare Benefits for Free Contact TriCare Directly
Tufts Health Plan Tufts Health Plan Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Tufts Health Plan Benefits for Free Contact Tufts Health Plan Directly
Unicare Unicare Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Unicare Benefits for Free Contact Unicare Directly
UnitedHealthOne UnitedHealthOne Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your UnitedHealthOne Benefits for Free Contact UnitedHealthOne Directly
United Healthcare United Healthcare Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your United Healthcare Benefits for Free Contact United Healthcare Directly
Wellmark Blue Cross and Blue Shield Wellmark Blue Cross and Blue Shield Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your Wellmark Blue Cross and Blue Shield Benefits for Free Contact Wellmark Blue Cross and Blue Shield Directly
WINhealth WINhealth Weight Loss Surgery Coverage Criteria Ask Local Surgeon to Check Your WINhealth Benefits for Free Contact WINhealth Directly
WPS Health Insurance No weight loss surgery coverage criteria available Ask Local Surgeon to Check Your WPS Health Insurance Benefits for Free Contact WPS Health Insurance Directly

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

Advertisement
03.

How to Get Your Insurance to Approve Gastric Sleeve Surgery

SECTION SUMMARY:

  • Read the 8 steps to gastric sleeve insurance approval below

If gastric sleeve insurance coverage is included under your policy, 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 gastric sleeve insurance approval process from start to finish can take anywhere from one month to one year.

Here is how to get insurance to pay for gastric sleeve:

  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
Click Here to See Your BMI
  1. Complete a medically supervised diet program. Gastric sleeve insurance criteria for the length of the program range from 3 to 7 consecutive months.
  2. Schedule a consultation with your bariatric surgeon.
  3. Schedule a consultation with your primary care physician to obtain a medical clearance letter.
  4. Schedule a psychiatric evaluation to obtain a mental health clearance letter.
  5. Schedule a nutritional evaluation from a Registered Dietitian.
  6. 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.
  7. 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.

Disability Insurance During Recovery

Your employer decides whether to offer Disability insurance (DI). You can continue coverage as an individual if you leave the company.

DI pays you a percentage of your monthly income if you are unable to work. Short term disability insurance (STD) usually pays 66 2/3 of your salary for the first 90 or 180 days of your recovery.

Disability insurance usually includes pre-existing conditions limitations. The best way around this is to sign up during the initial enrollment period (when you’re hired). They might not allow you to enroll at any other time. You then need to stay enrolled for the entire “pre-existing conditions exclusionary period,” which lasts between 6 and 12 months. Call your insurance company, talk with HR, or review your plan documents for details.

04.

Cost of Gastric Sleeve Surgery With Insurance

SECTION SUMMARY:

  • It could range from $0 to $3,500 out-of-pocket, depending on your plan and what you've paid so far for other medical services

Gastric sleeve cost with insurance averages about $3,500, but that amount could be much lower or higher depending on your policy. For example, if you’ve already satisfied your annual deductible and out-of-pocket maximum, the amount you have to pay for surgery will be much closer to $0 than $3,500.

Following are average gastric sleeve costs after insurance pays, depending on plan type:

  • HMO: $1,475
  • PPO: $2,542
  • POS: $2,270
  • High-Deductible Health Plan: $1,901

See below for assumptions

  • No money has been paid towards your calendar year deductible for other services
  • Calculations made using special formulas that take into account the average plan designs from Kaiser Family Foundation’s Annual Employer Health Benefits Survey (1)

Your final out of pocket cost after insurance depends on several factors, including:

Discounts Negotiated By Your Insurance Company

Insurance companies often have pre-negotiated rates for doctors and hospitals in their network. They may also try to negotiate deeper discounts on top of any negotiated rates.

Calendar Year Deductible Level

You must pay all medical costs until you reach your calendar year deductible amount. Some expenses, like copayments and prescriptions, do not count towards your deductible. Prescriptions may have their own Calendar Year Deductible.

After you reach the deductible, you share the cost with the insurance company. The amount you share depends on your Coinsurance percentage (see below).

Deductibles reset on January 1st. As a result, many weight loss surgery patients “rush” to get a surgery date before the end of each year.

Remaining Calendar Year Deductible Amount

The amount of money you still owe towards your deductible.

Hospital Copay

The amount you will pay for each hospitalization (including weight loss surgery). Does not count towards reaching the Calendar Year Deductible.

Hospital Coinsurance

The percentage of the total bill you are required to pay after you have “paid off” your Calendar Year Deductible.

Out of Pocket Maximum

This is the most you will have to pay through deductible and coinsurance before your plan pays 100%. You will still be responsible for copayments, such as:

  • Office visits
  • Hospital copays
  • Prescription drugs

Total Year-to-Date Coinsurance Paid

The total amount of coinsurance you have paid so far this calendar year. This is needed to determine whether your weight loss procedure will cause you to reach your annual out of pocket maximum.

Click here to contact a top gastric sleeve surgeon and ask for a free insurance check.

Advertisement
05.

The Average Cost of Gastric Sleeve Surgery Without Insurance

SECTION SUMMARY:

  • It costs $19,190, on average, but may be as low as $10,000 depending on the surgeon
  • If you take out a loan to cover the surgery, the payment will be about $445 a month
  • Discounts & tax savings are usually available to help cover your costs

The average total gastric sleeve cost without insurance is $19,000 but can be as low as $10,000 for some practices. That drops to around $3,500 with insurance (see the section above).

While surgery can be expensive, the good news is that:

  • Even if your insurance policy does not cover gastric sleeve surgery, you still may be able to get your insurance company to pay for some of the costs. For example, many plans will pay for certain pre-op tests, such as lab work, office visits, and psychological screening.
  • Gastric sleeve patients save about $11,000 per year compared to the medical costs they would have incurred had they remained obese. In other words, gastric sleeve pays for itself in under two years.
  • Special discounts are usually offered to “self-pay” patients
  • Out-of-pocket costs may be tax deductible
  • Loans are available to make it more affordable

See our Gastric Sleeve Cost page for more information or click here to contact a top gastric sleeve surgeon to ask for a free cost quote.

06.

Find a Top Gastric Sleeve Surgeon

SECTION SUMMARY:

  • You can ask a local bariatric practice for a free insurance check or cost quote
  • You can attend a free in-person seminar or an online webinar offered by a local weight loss surgeon
  • You should schedule a phone or in-person consultation (both often free), if you are interested in learning more about weight loss surgery

Search the gastric sleeve surgeon directory below to find a top surgeon by country and region:

Advertisement

* 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