Is Weight Loss Surgery Covered by Insurance?

In the past, many insurance companies did not pay for weight loss surgery. The surgeries are costly, many times costing over $25,000. Patients who wanted this option had to pay for the surgeries by themselves. Now, many insurance companies are starting to recognize the benefits of covering most forms of weight loss surgery. Not only do these surgeries help patients lose weight, but the surgeries also save the insurance company money in the long run. Patients who lose weight are less likely to suffer from other health related issues that can add up big for the companies.

Insurance coverage from weight loss surgeries varies by insurance company and state. If you are considering having this type of surgery, it is important to work with your doctor and insurance company to see what is or is not covered. Before most insurance companies agree to pay for these surgeries, patients must meet certain requirements and must be prepared for approval process to take a considerable amount of time. In order to be approved for insurance coverage for weight loss surgery, most companies recommend that the patient keep detailed records and send everything to their insurance provider.

Obesity is an expensive health problem. Those suffering from being overweight have all kinds of other health related diseases including high blood pressure, arthritis, heart disease, strokes, respiratory problems, sleep apnea and diabetes. It is estimated that obese people and insurance companies spend over $238 billion dollars treating obesity related health issues. In addition, obese people are more likely to suffer an early death than those who are of normal weight. Health insurance companies are starting to realize the amount of money spent on these illnesses and are beginning to cover most aspects of weight loss surgery. Covering these types of surgeries helps both the patient and the insurance company save a lot of money over a period of time.

The first step in becoming approved for weight loss surgery is to make sure you meet the National Institutes of Health criteria. This generally states that patients must be morbidly obese before qualifying for the surgery. This means that patients should be 100 pounds or more overweight or twice their body mass index rating. Sometimes insurance companies will allow these types of surgeries on patients who weight less than 100 pounds, if that person is suffering from debilitating illnesses that is directly related to obesity.

Patients considering weight loss surgery should completely understand their insurance’s company’s policy concerning these types of surgery. If you call your insurance company to ask questions, be sure to document all forms of correspondence. In addition, before seeing a weight loss surgeon, it is always a good idea to get a referral from your primary care doctor and make sure you have their support. Insurance companies are more likely to approve a surgery when they know another doctor feels the procedure is necessary. It is also recommended that a potential weight loss surgery patient have documentation and detailed records of everything related to their weight related issues. This includes weight loss programs, diet centers and fitness club memberships.