Insurance

Bariatric Surgery Insurance – How to Get Your Surgery Covered – Bariatric Surgery Source

Bariatric surgery insurance coverage varies by insurance policy. If your policy covers weight loss surgery and you meet the qualifying requirements, most plans will pay for you to have gastric sleeve, gastric bypass, gastric band, or duodenal switch surgery.

Your insurance costs can be as low as $0, depending on your policy. however, most insurance plans require the patient to pay part of the costs in the form of copays, deductibles, and coinsurance.

Reading: How to get insurance to pay for gastric bypass surgery

Please read and click below for additional details on weight loss surgery insurance.

index

click on any of the topics below to go directly to that section

  1. coverage by plan type
  2. covered procedures
  3. get approval
  4. find a weight loss surgeon
  5. insurance coverage by plan type & state

    Before looking up your insurance company’s specific coverage requirements for weight loss surgery, you should find out if your specific policy covers them. review the following plan types for more information:

    individual or family insurance

    Due to the passage of the Affordable Care Act (Obamacare), insurance companies in 23 states must cover weight loss surgery for all individual plans, family plans, and small group plans (employers with less than 50 full-time employees). The updated list below includes all Affordable Care Act weight loss surgery states.

    obamacare weight loss surgery statuses (for individual, family and small group plans)

    • arizona
    • california
    • red
    • delaware
    • hawaii
    • illinois
    • iowa
    • main
    • maryland
    • massachusetts
    • michigan
    • snowfall
    • new hampshire
    • new jersey
    • new mexico
    • new york
    • north carolina
    • north dakota
    • rhode island
    • south dakota
    • vermont
    • west virginia
    • wyoming
    • To confirm your coverage, you have a couple of options:

      • Option 1 (recommended): Your local surgeon will contact your insurance company to confirm your free benefits (even if you don’t go ahead with surgery) . Your 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 work for you. click here to find a local surgeon.
      • option 2: contact your insurance company and/or refer to the summary plan description (spd). See our page on Insurance Covering Bariatric Surgery for a complete list of insurance companies in the United States, contact information, and bariatric surgery coverage requirements.
      • If you discover that weight loss surgery is not covered, you still have several options for financing bariatric surgery to make treatment more affordable and to potentially lower your out-of-pocket costs.

        For more information on bariatric surgery and the Affordable Care Act, see our obamacare weight loss surgery page.

        if your insurance is through work: small groups (50 or fewer full-time employees)

        Weight loss surgery insurance coverage guidelines for small groups (50 or fewer full-time employees) are the same as for individual/family plans. click here to jump to that section.

        See also: Common Terms in Group Insurance | Benefit Design Services Corporation

        To confirm your small group bariatric surgery insurance coverage, you have three options:

        • Option 1 (recommended): Your local surgeon will contact your insurance company to determine the details of your coverage at no charge (even if you decide not to have surgery). Your office has been through the approval process with your insurance company many times, so let them work on your behalf to make the process as smooth as possible. click here to find a local surgeon.
        • Option 2: Ask your human resources (HR) department whether or not weight loss surgery is a benefit included in your plan.
        • option 3: contact your insurance company and/or check the summary plan description (spd). Click here for a complete list of US insurance carriers, contact information, and coverage criteria for bariatric surgery.
        • If you have short-term disability insurance through your employer, please also see our section on disability insurance. you may be able to receive a portion of your monthly salary while you undergo and recover from surgery.

          if your insurance is through work: large group (50+ full-time employees)

          If you get your insurance through your job and your employer has 51 or more full-time employees, it’s entirely up to your company to decide whether or not to cover weight-loss surgery.

          To confirm your coverage, you have three options:

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