Does Medicaid Cover Bariatric Surgery In Florida?

Does Medicaid Cover Bariatric Surgery In Florida? Many people wonder that Does Medicaid cover Bariatric surgery in Florida. First of all, it would be more accurate to give some general information.

Let’s talk about Bariatric Surgery Insurance Covearge. Most healthcare companies cover bariatric procedures. However, for bariatric surgeries, this coverage depends on whether there is a bariatric surgery advantage in the particular health care plan.

For bariatric surgery health insurance plan coverage, you should ask your insurance company about the following criteria:

1.You should make sure that bariatric surgery is included in your health insurance policy.

2.What percentage of the facility and physician’s bill will be your responsibility will also vary.

Although each insurance company has its own written bariatric surgery policy and requirements, here are some of the most common criteria:

1.Your own doctor should prepare a Medical Requirement Letter

2.You must have received a Nutritional Consult or monthly nutritional counseling for up to 9 months

3.Psychological evaluation

4.You must have followed a medical diet program with a specialist for at least two years. However, this program must have failed.

5.You must obtain medical clearance 30 days before the operation.

Weight loss surgery guidelines for Obamacare cover all individual, family, and Small Group plans. However, you must have your bariatric surgery performed in STATES where you can call it “Primary Health Aid”.

Legislators in each state determine Basic Health Benefits based on an average health insurance plan.

In the state of Florida, however, there is no requirement for insurance companies to include weight loss surgeries through Obamacare.

So, unfortunately, bariatric surgery will not be covered if you live in Florida and have health insurance under the Affordable Care Act.

So Does Medicaid Cover Bariatric Surgery In Florida?

Flat Medicaid plans in the state of Florida unfortunately generally do not cover bariatric surgery. But If you have a Humana Medicaid or United Medicaid plan, this plan will meet your bariatric surgery as long as you meet the necessary criteria.

However, Medicaid insurance in Florida covers diagnostic and treatment procedures and gastrointestinal services related to digestive disorders.

We can list the gastrointestinal services as follows:

1.Digestive surgery services including:

2.Surgery in which doctors manipulate the size of the stomach and reduce the stomach

3.Malabsorptive bariatric surgeries, where doctors completely change the digestive system and affect absorption

4.Surgery where doctors change both digestion and absorption with a combination of the two

5.Bariatric surgery revisions i.e. feedback of complications related to surgery


7.Stomach Physiology

In summary, it is suitable for gastrointestinal services that your doctor has indicated as medically necessary. Assuming your Madicaid insurance covers bariatric surgeries, you must meet certain conditions. Theese are:

1.You must be over 18 years old.

2.A specialist should diagnose you with morbid obesity.
So Body Mass Index (BMI) must be over 40

3.Or you must have a BMI of 35 to 39.9 and also have one of the following: severe sleep apnea, pickwick syndrome, cardiomyopathy, type II diabetes.

Naturally, if you live in Florida and your Medicaid insurance covers bariatric surgery, you will need to meet some general conditions.

If Your Own Policy Complies With Obamacare Rules

For Individual Plans and Family Plans, here are your options for getting your insurance approved to cover bariatric surgery:
• Your own surgeon can confirm your coverage free of charge by contacting your insurance company, even if you are not going to continue the surgery. Surgeons are familiar with insurance company approval processes, so you can trust them with confidence.
• You can definitely contact your insurance company yourself. And you should check your summary plan description.

There are three options for approving bariatric surgery insurance coverage for Health Plans Through Your Work:

Firstly your doctor can contact to your insurance company for you. Moreover it doesn’t change anything if you give up on surgery during the process. Your own surgeon has a great deal of control over insurance companies’ approval processes.

Secondly you can apply to the Human Resources Department of the company you work for about this issue.

Always valid option: you can contact your insurance company yourself. And check your Summary Plan Statement.

Medicare and Medicaid will cover bariatric surgery as long as you meet the guidelines listed below.

1. Body mass index should be over 35.
2. Must have at least one health problem caused by obesity.
3. Medical records of your failed treatments

Your surgeon should also be listed in The Centers for Medicare and Medicaid Services (CMS). The vast majority of surgeons do not accept Medicaid because of its low reimbursement rates. Because usually the payments provided by Medicaid are not enough to cover their costs.

Therefore, if you have Medicaid insurance, you should ask your surgeon if he or she will accept this insurance. If he does not agree, you can ask him to refer you to another surgeon who will accept your insurance.

Let’s Wrap Up

Let’s list the Insurance Covered and Not Covered Transactions Covering Bariatric Surgery as follows: Most health plans that cover bariatric surgery insurance will agree to pay for sleeve gastrectomy, gastric bypass surgery, gastric band surgery (lap band surgery), duodenal replacement surgery. (Of course, if you meet the coverage criteria)
Generally, insurance companies do not cover gastric balloon, assist assistant, experimental procedures. Assuming your insurance plan covers bariatric surgery insurance, you must meet all of your insurance coverage criteria to confirm you need medical surgery. The process, which includes all these processes, can take from a month to a year.

Finally, you can get more detailed and precise information about this process by contacting your insurance. Because insurance companies can file each customer’s file separately and evaluate it accordingly.

Remember, your doctor and insurance company will always be ready to implement the methods that work best for you. If you are not satisfied, you can always change them. Or you can change your plan to cover the costs of bariatric surgeries.

We tried to answer your question with this article. Unfortunately, if you are Medicaid Insured in Florida, you have limited opportunities for bariatric surgeries and procedures.

Does Medicaid Cover Weight Loss Surgery? Get Prepared


The answer to “does Medicaid cover weight loss surgery?” is yes, it does cover weight loss surgery in certain circumstances. For instance, if it is deemed a medically necessary procedure to treat an underlying medical condition. However, the coverage varies from state to state and is also subject to individual provider’s policies. To help prepare for any possible surgeries, individuals should research their state’s Medicaid guidelines and speak with their healthcare provider regarding coverage details and any other necessary preparation steps. Additionally, it may be beneficial to work with a nutritionist and/or dietitian who can provide guidance on making lifestyle changes that would have a positive impact during the surgical process.

Taking these steps will help make sure that you are well-informed and ready in the event you decide stomach surgery for weight loss is the right decision for you. Ultimately, it is important to do your research on “does Medicaid cover weight loss surgery?” before deciding to understand if weight loss surgery is the right choice for your health needs. It is also important to research the types of weight loss surgeries available and which ones are most effective and safest for you personally before submitting your coverage application.