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We all know that insurance companies are notoriously stingy when it comes to covering medical procedures. So is weight loss surgery covered by insurance? The answer may surprise you.
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More than one-third of adults in the United States are obese, and obesity-related illnesses are some of the most expensive to treat. Bariatric surgery can help people achieve and maintain significant weight loss, but it is not a quick fix or a cure-all. The decision to have surgery is complex, and should only be made after careful consideration.
There are several types of weight loss surgery, all of which fall under the umbrella of “bariatric surgery.” The most common procedures are gastric bypass, sleeve gastrectomy, and gastric banding. All of these procedures involve making changes to the stomach and/or intestines in order to limit the amount of food that can be consumed or the number of calories that can be absorbed.
Weight loss surgery is usually covered by insurance, but there are some exceptions. To qualify for coverage, you will typically need to meet certain criteria, such as having a body mass index (BMI) over 40 or 35 with certain obesity-related health conditions. coverage may also require that you have tried other weight loss methods without success.
If you are considering weight loss surgery, your first step should be to talk to your doctor about your options and whether or not you might be a candidate for coverage.
What is Weight Loss Surgery?
Weight loss surgery is a life-changing and effective treatment for obesity. It has been shown to help people lose a significant amount of weight and keep it off long-term.
There are different types of weight loss surgery, but the most common is gastric bypass surgery. This involves making a small incision in the stomach and creating a new, smaller stomach pouch. The small intestine is then re-routed to connect to this new pouch, bypassing the larger portion of the stomach. This reduces the amount of food that can be eaten, as well as the number of calories and nutrients that are absorbed.
Weight loss surgery is usually only recommended for people who are significantly overweight (with a BMI of 40 or more) or who have obesity-related health problems such as type 2 diabetes, high blood pressure, or sleep apnea.
##Heading: Is Weight Loss Surgery Covered By Insurance?
Weight loss surgery is usually covered by insurance if you meet certain criteria. Most insurance companies require that you have tried other weight loss methods, such as diet and exercise, and have been unsuccessful in losing weight. You will also need to have a consultation with a bariatric surgeon to see if you are a good candidate for surgery.
If you do not have insurance or your insurance does not cover weight loss surgery, there are other options available. Many bariatric surgeons offer financing options to make surgery more affordable. You can also check with your local hospital to see if they offer any discounts for uninsured patients.
Types of Weight Loss Surgery
There are several types of weight loss surgery, and each has different eligibility requirements.
-Gastric sleeve: Also called vertical sleeve gastrectomy, this surgery removes about 80 percent of your stomach. It’s irreversible.
-Gastric bypass: This surgery divides your stomach into a small upper section and a much larger lower section. The small upper section is attached to the small intestine, bypassing the rest of the stomach and the upper part of the small intestine. It’s irreversible.
-Gastric band: An adjustable band is placed around the top of your stomach to create a small pouch for food. The band can be tightened or loosened as needed. It’s reversible.
To be eligible for weight loss surgery, you typically must:
Have a body mass index (BMI) of 40 or higher, or have a BMI between 35 and 39 and an obesity-related health condition such as type 2 diabetes, high blood pressure or sleep apnea
Have tried — for at least six months — to lose weight through diet and exercise
Understand the risks and benefits of the different types of weight loss surgery
Be willing to make lifestyle changes, including following a healthy diet and participating in regular physical activity
Be committed to long-term follow-up care
Who is Eligible for Weight Loss Surgery?
Weight loss surgery is usually only available to people who are obese, with a BMI of 30 or above. In some cases, people with a BMI of 25-30 may be eligible if they also have other conditions that could be improved by weight loss, such as type 2 diabetes or high blood pressure.
There are different types of weight loss surgery, and the one that’s suitable for you will depend on your individual circumstances. The most common procedures are gastric bands, gastric bypasses and gastric sleeves.
Gastric bands involve fitting a band around the stomach to create a small pouch at the top that restricts how much food can be eaten at one time. Gastric bypasses involve rerouting the digestive system past the majority of the stomach so that less food is absorbed. Gastric sleeves involve removing a large portion of the stomach so that the remaining stomach is smaller in size.
Weight loss surgery is usually done under general anaesthetic and takes around 1-3 hours, depending on the type of procedure. It’s important to bear in mind that weight loss surgery is not a quick fix and it won’t work unless you make long-term changes to your diet and lifestyle.
Does Insurance Cover Weight Loss Surgery?
Weight loss surgery is a major decision, and one that comes with a lot of financial considerations. The good news is that most insurance companies do cover weight loss surgery, and in many cases will cover the entire cost of the procedure.
There are a few things to keep in mind when it comes to insurance coverage for weight loss surgery. First, coverage varies from insurer to insurer, so it’s important to check with your specific company to see what they will and won’t cover. Secondly, most insurance companies require that you meet certain criteria before they will approve coverage for weight loss surgery. These criteria usually include having a body mass index (BMI) of 40 or higher, or a BMI of 35 or higher with certain comorbidities such as type 2 diabetes or sleep apnea.
If you do meet the criteria for insurance coverage, the next step is to Choose a Weight Loss Surgery Procedure that is covered by your insurer. There are several different types of weight loss surgery procedures, so be sure to ask your surgeon which ones are covered by your insurance policy.
Once you have chosen a procedure, the next step is to find a Weight Loss Surgery Center that is in-network with your insurance company. In-network providers have pre-negotiated rates with insurance companies, so you will likely pay less out-of-pocket than you would at an out-of-network provider.
If you have any questions about whether weight loss surgery is covered by your insurance policy, or about how to find an in-network provider, please contact us and we will be happy to help!
How Much Does Weight Loss Surgery Cost?
Weight loss surgery is not cheap. The average cost of gastric bypass surgery is $23,000, while the average cost of lap band surgery is $14,500. Most insurance companies will not cover the cost of weight loss surgery unless it is deemed medically necessary. This means that you will likely have to pay for the surgery out of pocket.
Generally, weight loss surgery is covered by insurance if you meet certain criteria. These criteria usually involve having a BMI of 40 or higher, or a BMI of 35 or higher with other weight-related health conditions. If you don’t meet these criteria, you may still be able to get insurance coverage if your doctor can prove that weight loss surgery is medically necessary.