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Will My Insurance Cover Weight Loss Surgery?

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If you’re considering weight loss surgery, cost is a factor. So too is whether or not your health insurance will cover your procedure. Bariatric surgery is an investment in both your health and your future. However, questions surrounding insurance coverage can complicate the decision-making process, and sometimes even keep patients from seeking the help they need to lose weight.

Luckily, many major health insurers will cover the cost of bariatric surgery as long as the patient meets specific requirements. These vary from insurer to insurer, but common prerequisites include:

  • A body mass index (BMI) measurement of 35+ accompanied by health conditions associated with obesity, such as heart disease, diabetes, etc.
  • A BMI measurement of 40+ unaccompanied by underlying health conditions or comorbidities.

Insurers who cover weight loss surgery typically also require that the patient receive psychological counseling and meet with a dietitian prior to being approved for surgery. In some cases, patients may also be asked to complete a sleep study in order to determine whether or not they are a good candidate for bariatric surgery.

Your insurer may also request a letter of medical necessity before approving coverage for your weight loss surgery. This letter states the medical case for the bariatric procedure and explains why performing it is pertinent to your overall health. The letter of necessity will also include relevant information drawn from your medical history, such as:

  • How long you have been overweight or obese.
  • Which diet and weight loss programs you may have tried in the past.
  • Your current weight.
  • Documentation proving that you meet the insurer’s BMI qualifications.
  • Any other documentation regarding health issues related to your being overweight or obese.

McCarty Weight Loss Center accepts most private insurance. Nevertheless, even if your weight loss procedure is covered by your insurer, you will still be responsible for deductibles and co-pays as specified in your policy. However, if your plan gives you access to a flexible spending account (FSA), a health savings account (HSA) or a health reimbursement account (HRA), you may be able to use these funds to cover the costs associated with your bariatric surgery.

If you are uncertain whether or not your health insurance will cover your weight loss surgery, we can help. We will work with your insurance provider to verify your level of coverage. (You can also review a list of pre-surgical requirements and scopes of coverage, organized by health insurance provider, here.) We also offer a variety of surgery payment options, and we’re happy to help you determine which option makes the most sense for you. Learn more about those options here.

We have more than 20 years of experience working with insurance companies. Our team of experts will advocate on your behalf to secure insurance approval, maximum surgery coverage and reduced out-of-pocket expenses.

Are you ready to take the next step toward losing weight for good? To get started, fill out this form to verify your insurance benefits.