Are you too wondering does insurance cover weight loss? Then read on for this article is just for you.
What is weight loss surgery?
The two most common surgeries for weight loss are gastric bypass and lap band surgery. Gastric bypass cuts off a portion of the stomach and re-routes part of the intestines, limiting food intake. Lap band surgery uses an inflatable band placed around the top section of the stomach to limit food intake. Because it is reversible, the band itself does not require surgery to remove it.
Who might qualify for weight loss surgery?
According to a Weight Loss Surgery in Maryland, to be a candidate for weight-loss surgery, you must be at least 18 years old and have a body mass index of 40 or more, or a BMI equal to 35 with obesity-related comorbidities such as Type 2 diabetes, high blood pressure or sleep apnea. In addition, you must be in good general health and have tried dieting and exercise without success for at least six months.
How much does it cost and how long is the recovery period?
Weight-loss surgery can vary in price depending on hospital cost and what type of surgery is done, but it can cost more than $20,000. The average hospital stay after weight-loss surgery will be about three days.
Will health insurance pay for bariatric surgery?
The good news is that today most insurance companies will cover weight-loss surgery in certain circumstances. It depends on the types of weight loss surgery you must know as well to check if any surgery you can opt for is included.
As you’ll see, however, there are still exceptions: Medicare and Medicaid do not pay for bariatric surgery unless it is a part of a clinical study, the surgery is done to treat cancer or another qualifying medical condition. Several states also have laws that dictate who may receive insurance reimbursements for weight loss surgery.
If you are a potential bariatric surgery candidate, your insurance company will likely require that you meet certain criteria prior to approval of the procedure. Some insurance providers might require meeting with a behavioral counselor or undergoing psychological evaluation before approving coverage for bariatric surgery. Insurance companies typically want to see that patients have done everything possible to lose weight through diet and exercise before approving surgery. In some cases, insurance providers will offer long-term psychological support after bariatric surgery as well.
To start, check with your insurer to see what weight loss procedures are covered by insurance and maximum benefits payable. You will likely be asked the name of the hospital or surgeons’ offices where you plan to have the surgery performed, its address and phone number, copies of all applicable office policies and agreements (with you and your surgeon), the specific models of equipment used in the OR (such as operating table, anesthesia machine, lighting) and copies of any applicable agreements with those businesses.
Most companies for weight loss surgery insurance specify that you must receive pre-authorization for bariatric surgery benefits to be payable — some even insist on it before they will issue or renew your health plan. In some cases, you may be required to undergo psychological and nutritional counseling before bariatric surgery.
Thus, the answer is YES, bariatric surgery is covered by insurance but there are exceptions. Its best to communicate to your insurance company and bariatric surgeon to know if you are eligible for the insurance and if so, how much will be covered.
