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Medical Mutual of Ohio Weight Loss Surgery Requirements & Free Insurance Check

Medical Mutual of Ohio Weight Loss Surgery Requirements & Free Insurance Check

Your Medical Mutual of Ohio weight loss surgery insurance coverage depends on several factors, all of which are reviewed below.

First, try our insurance tool to quickly check your insurance coverage:

WHICH PROCEDURE IS BEST FOR YOU?CLICK HERE TO TAKE THE QUIZ

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

TABLE OF CONTENTS

Click on any of the topics below to jump directly to that section

  1. Coverage Requirements
  2. Coverage Plans
  3. Covered Procedures
  4. Appealing a Denial
  5. Find a Weight Loss Surgeon
01.

Coverage Requirements

SECTION SUMMARY:

  • 35+ Body Mass Index (BMI)
  • Documentation of failed diet attempts
  • Psychological evaluation

READ THIS FIRST

Even if your insurance company covers bariatric surgery in some plans, that does not mean that your specific plan covers it. The obesity surgery approval requirements in this section assume that weight loss surgery is covered by your specific policy.

To confirm whether your specific policiy covers bariatric surgery, click here to contact a surgeon and ask for a free insurance check.

Find a Weight Loss Surgeon

Disclaimer: The information contained on this page may not include all components of your insurance company’s medical policy and/or may not be up to date. Contact your insurance company to confirm all benefits.

In order to be approved by Medical Mutual of Ohio for bariatric surgery in the United States, you must meet the following criteria:

  1. Be age 18 years or older
  2. Diagnosis of Morbid obesity, defined as

    3. Or

    • BMI 35 – 39.9 AND one of the following
      • Hypertension
      • Sleep apnea
      • Pickwickian syndrome
      • Obesity-related cardiomyopathy
      • Diabetes mellitus
      • Physical problems severely interfering with function (e.g., joint disease that would otherwise be treatable)

    Use this BMI Calculator to check your body mass index…

  3. Participation is a medically supervised weight loss program for more than 3 consecutive months within 18 months preceding the request for bariatric surgery.
  4. Evaluation by licensed psychologist or psychiatrist indicates no behavioral health factors precluding a successful outcome of bariatric surgery, does not have a major uncontrolled psychiatric disorder, and is able to comply with the recommended medical/surgical preoperative and postoperative treatment plans.
  5. Medical clearance to proceed with surgery from appropriate specialists relative to existing comorbid disease states.
  6. Information regarding probable and potential postoperative complications, dietary and medical postoperative limitations and potential cosmetic sequelae has been received by the individual.
  7. Medical record documentation supports all of the above criteria and includes dated weight measurements for more than 12 months indicating morbid obesity.

Revision Requirements

Revisions are considered medically necessary if the surgery is to correct documented clinically significant complications (e.g., obstruction, stricture, band slippage, dehiscence, anastomotic leak) of previous bariatric surgery procedure.

If Your Policy Does NOT Cover It: Seek Partial Coverage

You may be able to get part of the costs paid for by insurance even if weight loss surgery isn’t covered. It’s all about how your doctor and hospital submit your claims to your insurance company.

For example, there are many non-bariatric surgery reasons for your doctor to recommend:

  • Cardiology exam
  • Lab work
  • Medically supervised diet program
  • Psychological exam
  • Sleep study

These are ordered for many reasons other than bariatric surgery and may be covered as a result. If your doctor submits one of these claims using a weight loss surgery CPT code (Current Procedural Terminology Code), your insurance is unlikely to cover it. But if your doctor uses a general CPT code, it probably will be covered.

While this may sound “sneaky”, it is an ethical practice. After all, these tests will be beneficial regardless of whether you move forward with surgery.

Medical Mutual of Ohio Contact Information and Full Medical Policy on Bariatric Surgery

02.

Coverage by Plan Type

SECTION SUMMARY:

  • Coverage Through Your Employer
  • Individual & Family Plans
  • Medicare

Before getting into the types of insurance plans, you can cut to the chase by contacting a local bariatric surgeon’s office. Most surgeons will contact your insurance company for free to confirm whether or not you’re covered.

Click here to find a local surgeon and ask them to check your insurance for you for free.

Medical Mutual of Ohio does cover weight loss surgery, but your specific policy must include it in order for you get it covered.

Following are a list of Medical Mutual of Ohio plan types and whether they cover bariatric surgery:

Weight Loss Surgery for Health Plans Through Your Work

If you work for a company that has 50 or more full time employees, it is completely up to your employer to decide whether or not to cover bariatric surgery under your health plan.

To find out whether weight loss surgery is covered by your employer’s plan, you have a few options:

Weight Loss Surgery for Individual/Family Plans

The Affordable Care Act (Obamacare) requires all individual and small group plans (less than 50 full time employees) to include weight loss surgery coverage as long as it is considered an “Essential Health Benefit” in your state.

The following states DO currently consider bariatric surgery an Essential Health Benefit (bariatric surgery is covered by all individual, family and small group plans in these states):

Your State Not on the List?

If your state is NOT on the list, then weight loss surgery is probably NOT covered under your plan.

First, contact your local surgeon to be sure. For no charge, their office will contact your insurance company on your behalf to work through the details.

If your surgeon confirms that your policy does not include obesity surgery, you still have several options for making surgery more affordable. See these pages for more information:

    • 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

Regardless of whether your state is on the list, contact a qualified surgeon to request a free insurance check to verify your coverage.

To review your insurance company’s obesity surgery coverage requirements, click here to jump back up the page.

Weight Loss Surgery for Medicare Plans

All Medicare plans are required to cover the following weight loss surgery procedures:

However, special Medicare-specific criteria apply. Click here to learn more about Medicare bariatric surgery coverage.

03.

Covered Weight Loss Procedures

SECTION SUMMARY:

  • Gastric Sleeve
  • Gastric Bypass
  • Lap-Band
  • Duodenal Switch
  • Vertical Banded Gastroplasty

Please see below for the procedures Medical Mutual of Ohio covers, might cover under certain circumstances, and those that are not covered under any circumstances:

Procedures That ARE Covered

Procedures That MIGHT BE Covered

The following procedures MIGHT BE covered by Medical Mutual of Ohio:

Procedures That Are NOT Covered

The following procedures are NOT covered by Medical Mutual of Ohio:

04.

Appealing a Denial

SECTION SUMMARY:

  • General Appeal Instructions
  • Appeal Details Specific to Medical Mutual of Ohio

If Medical Mutual of Ohio denies your weight loss surgery claim and you think it should be covered, consider filing an appeal.

Our Health Insurance Appeals page will get you started, then head over to the Disputes & Appeals page for Medical Mutual of Ohio to learn how to proceed.

05.

Find A Top Weight Loss Surgeon

SECTION SUMMARY:

  • 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)

Search the weight loss surgeon directory below to ask a surgeon about a free insurance check by country and region:

TOOLS
FIND A SURGEON
DO YOU QUALIFY?
CHECK MY INSURANCE
WEIGHT LOSS ESTIMATOR
COST COMPARE
Apply for Loan (Ad)
Tax
Write-Offs
RECOVERY TIMELINES
PROCEDURE SUMMARIES
COMPARE PROCEDURES
Best Procedure Quiz
HEALTH BENEFITS

Find a Bariatric Surgeon

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Find a Bariatric Surgeon

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[get_data_from_ci_map_list url="maplist/maplistNewdesign"]
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Do You Qualify for a Bariatric Procedure?

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Do You Qualify for a Bariatric Procedure?

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Do You Qualify for a Bariatric Procedure?

Patients who qualify for bariatric surgery usually:

  • Are at least 80 lbs (36 kg) overweight
  • Are between 18 and 75 years old
  • Have a history of failed weight loss attempts (e.g., failed diets)
  • Thoroughly understand that the procedure is just a tool; long-term success requires significant diet and lifestyle changes

The minimum bariatric surgery qualifications include:

  • A body mass index (BMI) of 40 or more
  • OR a BMI between 30 and 39.9 with a serious obesity-related health problem like diabetes, high blood pressure, sleep apnea, high cholesterol, joint problems, or others
  • OR a BMI of 30 to 40 with or without health issues for the gastric balloon procedure

To calculate your BMI, enter your height and weight into the tool, then click the “Calculate BMI” button.

Click here to learn more
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Check My Insurance Tool

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Check My Insurance Tool

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Check My Insurance Tool

Bariatric surgery insurance coverage varies by insurance policy:

Individual/Family Plans & Small Group Plans – Coverage varies by state; coverage is required by the Affordable Care Act in some states

Large Group Plans – Coverage depends on whether your employer has chosen to add it to your policy

Medicare and Medicaid – Bariatric surgery is covered

If your policy covers it and you meet the qualification requirements, your plan will likely include 4 procedures:

  • Gastric sleeve
  • Gastric bypass
  • LAP-BAND®
  • Duodenal switch

Your surgeon may be able to get partial coverage for the other procedures.

Use the tool to find out if your insurance covers bariatric surgery.

Click here to learn more
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Bariatric Surgery Weight Loss Estimator Tool

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Bariatric Surgery Weight Loss Estimator Tool

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Bariatric Surgery Weight Loss Calculator

You will start losing weight fast after any bariatric surgery procedure, but the total amount lost varies based on:

  • The procedure you choose
  • How closely you follow your doctor’s instructions

Enter your information into the tool to get an idea about how much weight you’ll lose after each procedure.

Click here to learn more

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Bariatric Procedure Cost Compare Tool

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Bariatric Procedure Cost Compare Tool

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Bariatric Procedure Cost Compare Tool

Your out-of-pocket bariatric surgery cost can range anywhere from $0 to $20,000 or more depending on several factors, including:

Whether your insurance covers it – many insurances (including Medicare, Medicaid, and many individual/family and employer-provided policies) cover the majority of costs for gastric sleeve, gastric bypass, LAP-BAND®, and duodenal switch. The other types of bariatric surgery are less likely to be covered, although you may be able to get insurance to pay for some of the costs. Tap the “With Insurance” button in the tool to see average out-of-pocket costs per procedure after insurance pays. See our Insurance Tool to find out if your plan covers it.

Which procedure you choose – if insurance won’t pay, costs range anywhere from $8,000 to $20,000+, depending on the procedure. Tap the “Without Insurance” button in the tool to compare the national average self-pay costs for each procedure. (NOTE: Some surgeons offer each procedure for as low as half of the national average).

How competitive your surgeon and hospital fees are – there is often a substantial difference in costs between different doctors and hospitals, even within the same town.

Whether you qualify for tax write-offs – Bariatric surgery is tax deductible, which can have a big impact on the total cost of surgery. You can deduct medical expenses if your out-of-pocket costs are more than 10% of your adjusted gross income. See our Tax Tool to find out if your bariatric procedure will be tax deductible.

How you choose to pay for your procedure – If insurance covers it, you’ll only be responsible for any copays, deductibles, and coinsurance required by your specific plan. If you pay for the procedure without insurance, total costs will depend on how you pay. For example, your surgeon may offer a discount if you pay the full amount up front, and you can make the costs more affordable by applying for bariatric surgery financing.

Click here to learn more
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LOAN ESTIMATOR TOOL

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LOAN ESTIMATOR TOOL

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Bariatric Surgery Tax Write-Off Calculator

Weight loss surgery is tax deductible, which can have a big impact on the total cost of surgery. You can deduct medical expenses if the costs are more than 10% of your adjusted gross income.

Use the tool to find out if you qualify for a tax deduction.

To receive the deductions, you’ll need to complete Schedule A of the IRS Form 1040. You’ll also need to save your medical bills and payment statements as proof. Money in one of the following special savings accounts (or even your IRA) may also be a way to pay for part of surgery tax-free:

  • Health Savings Account (HSA)
  • Archer Medical Savings Account (Archer MSA)
  • Health Reimbursement Account (HRA)
  • Flexible Spending Account (FSA)
Click here to learn more
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Bariatric Surgery Tax Write-Off Tool

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Bariatric Surgery Tax Write-Off Tool

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Bariatric Surgery Tax Write-Off Calculator

Weight loss surgery is tax deductible, which can have a big impact on the total cost of surgery. You can deduct medical expenses if the costs are more than 10% of your adjusted gross income.

Use the tool to find out if you qualify for a tax deduction

To receive the deductions, you’ll need to complete Schedule A of the IRS Form 1040. You’ll also need to save your medical bills and payment statements as proof.

Money in one of the following special savings accounts (or even your IRA) may also be a way to pay for part of surgery tax-free:

  • Health Savings Account (HSA)
  • Archer Medical Savings Account (Archer MSA)
  • Health Reimbursement Account (HRA)
  • Flexible Spending Account (FSA)
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Bariatric Surgery Recovery Timeline Tool

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Bariatric Surgery Recovery Timeline Tool

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Bariatric Surgery Recovery Timeline Tool

Bariatric surgery recovery varies by procedure. Here are the ranges:

  • Timeline Range: from 3 days to 6 weeks to full recovery
    • Hospital Stay: from outpatient (return home same-day) to 3 days
    • Back to Work: from 3 days to 3 weeks
  • Pain Range: from mild discomfort to manageable with medication
  • Diet Range: from no restrictions to slow transition from clear liquids to solid foods
  • Activity Range: from no restrictions to slow transition back to regular activity and exercise

Use the tool to learn more about each stage of recovery.

Click here to learn more
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Bariatric Procedure Summaries

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Below is a brief explanation of how each bariatric surgery procedure works. Tap the icons for more information.

Bariatric Procedure Summaries

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Below is a brief explanation of how each bariatric surgery procedure works. Tap the icons for more information.

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Bariatric Procedure Comparison Tool

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Bariatric Procedure Comparison Tool

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Bariatric Procedure Comparison Tool

There are 6 types of bariatric surgery (also called “weight loss surgery”) available, including:

  • Gastric Sleeve – feel less hungry & full sooner while eating
  • Gastric Bypass – feel full sooner while eating & absorb fewer minerals
  • Duodenal Switch – feel less hungry & full sooner while eating, absorb fewer calories and minerals
  • LAP-BAND® – feel full sooner while eating
  • Gastric Balloon – temporarily feel full sooner while eating (balloon removed after 6 months)
  • AspireAssist – drain a portion of stomach contents after eating

Use the tool to compare each procedure.

Click here to learn more
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Bariatric Surgery Quiz: Learn Your Top 2 Procedures

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Bariatric Surgery Quiz: Learn Your Top 2 Procedures

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Bariatric Surgery Quiz: Learn Your Top 2 Procedures

The best weight loss surgery options for you depend on:

  • How much weight you want to lose
  • Your current age, weight, health issues, habits, and lifestyle
  • Your expectations for life after surgery
  • Whether you want a reversible procedure
  • What “trade-offs” you are willing to make

Take the quiz to find out which two procedures are best for you and why.

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Bariatric Surgery Health Benefits Tool (Gastric Sleeve)

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Bariatric Surgery Health Benefits Tool (Gastric Sleeve)

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Bariatric Surgery Health Benefits Tool

Bariatric surgery “cures” or significantly improves many obesity-related health conditions, including:

  • Diabetes
  • Sleep apnea
  • Hypertension
  • Joint issues
  • … and many others

Select your health conditions in the tool, then click the Submit button to find out the impact a procedure like gastric sleeve can have.

Click here to learn more
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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. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. Read More

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