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
TABLE OF CONTENTS
Click on any of the topics below to jump directly to that section
- 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)
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Carolina
- North Dakota
- Rhode Island
- South Dakota
- West Virginia
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 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.
- A body mass index (BMI) over 35
- At least one co-morbidity (health problem) related to obesity
- 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:
- Gastric sleeve surgery (laparoscopic only)
- Gastric bypass surgery (open or laparoscopic)
- Lap band surgery (laparoscopic only)
- Biliopancreatic diversion with duodenal switch (BPD/DS) (open or laparoscopic)
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.
- 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…
Can’t find your insurance company/plan or have an updated link? Click here to contact us.
- 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:
- 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
- Complete a medically supervised diet program. Gastric sleeve insurance criteria for the length of the program range from 3 to 7 consecutive months.
- Schedule a consultation with your bariatric surgeon.
- Schedule a consultation with your primary care physician to obtain a medical clearance letter.
- Schedule a psychiatric evaluation to obtain a mental health clearance letter.
- Schedule a nutritional evaluation from a Registered Dietitian.
- 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.
- 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.
- 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.
The amount you will pay for each hospitalization (including weight loss surgery). Does not count towards reaching the Calendar Year Deductible.
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.
- 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.
- 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: