Many insurance companies will at least partially cover weight loss surgery if you meet certain criteria. But these can vary by insurance company, so be sure to check your specific plan.
Because a variety of health complications are linked to obesity, a doctor or other healthcare professional may suggest different weight loss measures if you have overweight. In some cases, they’ll recommend weight loss surgery.
Eating disorders
If you’re preoccupied with food or your weight, feel guilt about food choices, or engage in restrictive diets, consider reaching out for support. These behaviors may indicate a disordered relationship with food or an eating disorder.
Disordered eating and eating disorders can affect anyone, regardless of gender identity, race, age, socioeconomic status, or other identities.
They can be caused by any combination of biological, social, cultural, and environmental factors — not just by exposure to diet culture. Consider speaking with a healthcare professional or contacting the National Alliance for Eating Disorders, which offers a daytime helpline staffed by licensed therapists and an online search tool for treatment options. For general mental health support at any time, you can call the Substance Abuse and Mental Health Services Administration 24 hours a day at 1-800-662-4357 (or 1-800-487-4889 for TTY).
If you meet certain requirements, your health insurance may cover some or all of the costs. Medicare and Medicaid can also cover them.
Read on to learn more about insurance approval criteria for weight loss surgery and what to expect.
Insurance requirements to cover a weight loss surgery can vary from plan to plan, so it’s important to check yours. Some common criteria include:
- an elevated body mass index (BMI)
- health complications like hypertension, cardiovascular disease, or diabetes
- documented efforts in a weight loss program over a period of time
- nutritional and psychological evaluations
If you meet certain criteria, Medicare and Medicaid will cover surgeries including gastric bypass and laparoscopic banding.
The criteria for Medicaid to cover your weight loss surgery can include:
- BMI levels in the obese range
- a related health complication
- laboratory blood work and diagnostic scans
- documentation of participation in a weight loss program
- psychological and nutritional evaluations
Medicaid will not cover the cost of weight loss surgery if you:
- currently have a documented binge eating disorder
- are pregnant or plan to become pregnant within 2 years of the surgery
- are actively engaging in drug or alcohol misuse
It’s important to keep in mind that many individuals notice extra skin or folds after weight loss surgery. Medicaid will not cover the cosmetic surgery to remove this, so you’ll need to pay for it yourself.
Weight loss surgery is covered by many insurance companies. Some insurance providers that have covered weight loss surgery include:
- Aetna
- Anthem Blue Cross Blue Shield
- Cigna
- Oscar
- Tricare
- United Health Care
- Humana
If you’re interested in learning more about different health insurance companies, you can read more here.
Some factors that can influence the price of your weight loss surgery include:
- surgery type (i.e., gastric bypass, sleeve gastrectomy, gastric band surgery)
- whether or not you’ll need to stay in the hospital overnight
- how experienced the surgeon is
- where your surgery is performed
Along with your quoted surgery cost, you may need to budget for:
- necessary follow-up appointments
- consultation fees
- anesthetic or surgical assistant fees
Your insurance company may deny your claim if your policy doesn’t cover weight loss surgery. They might also deny it if you don’t meet the criteria or are missing the required documentation.
Communicating with both your insurance company and the doctor’s office before the surgery can help to ensure that your claim isn’t denied.
There are several different types of weight loss surgery. These
There are also new weight loss devices approved by the Food and Drug Administration (FDA) that a doctor may be able to place and remove without performing surgery.
Additionally, not all doctors and surgical locations will cost the same amount. You might want to get quotes from different healthcare professionals and facilities in order to compare prices.
If your insurance won’t cover your weight loss surgery, you can ask about financing options like flexible payment plans. These can help to make surgery more affordable.
Weight loss surgery can be expensive, but it may be covered by your health insurance if you meet certain criteria.
Before paying toward your weight loss surgery, your insurance may require proof of related health conditions as well as documented efforts over time to lose weight.
If you’re planning to undergo weight loss surgery, it’s important to check with your insurance to confirm what’s covered by your policy as well as any requirements for this coverage.
