Insurance That Covers Weightloss Surgery

Different states and insurance companies cover weight loss surgery in different ways. If you are thinking about weight loss surgery, the first thing you should do is find the insurance that covers weightloss surgery to see if the procedure is covered and if there are any restrictions. Gastric bypass insurance is now offered by both public and private insurance companies.

Some insurance companies may pay the whole bill. However, many public or private insurance companies that cover weight loss surgery will pay 80 percent of what the insurance company decides is “normal and customary” for the surgery.

How To Find The Insurance That Covers Weightloss Surgery?

Medicare, the government health plan for people 65 and older in the United States, recently said that it will pay for three types of weight loss surgery for people who are treated in “high-volume centers with low mortality rates.”

Medicare will pay for the following three types of surgery:

The route around Roux-en-Y. In this surgery, surgical staples are used to make a small pouch in the stomach. This pouch is linked to the bowel by a piece of the small intestine. So most of the stomach is skipped over.

There are both open and laparoscopic biliopancreatic diversions. In these procedures, a large part of the small intestine is bypassed and digestive juices from the liver and pancreas are sent to the lower part of the intestine.

Laparoscopic gastric banding that can be changed. In this surgery, a small piece of the stomach is cut off with an adjustable band.

Medicare Coverage Requirements

Before Medicare will pay for weight loss surgery, candidates usually have to take part in a six-month medically supervised weight loss program through their bariatric surgeon or their primary care doctor. Contact your local Medicare provider to find out what you need to do about your diet history. As it stands, Medicare patients with a body mass index (BMI) of 35 and at least one health problem related to obesity. Such as heart disease or diabetes, can get weight loss surgery.

Medicare does, however, require that the surgery to lose weight be done at a certain certified place. Before they will pay for weight loss surgery, many private insurers need a letter from a doctor saying that it is medically necessary. Medicare, on the other hand, does not need this kind of pre-approval or pre-certification. After doing the surgery on a person who meets all of Medicare’s requirements for weight loss surgery, the surgeon will send the claim to Medicare. Some surgeons may ask Medicare patients to sign a contract saying that they will pay for any costs that Medicare doesn’t cover after it processes the claim.

Medicaid And Surgery To Lose Weight

Medicaid is a health care plan for people and families with low incomes that is run by the federal government. Whether or not Medicaid pays for weight loss surgery depends on the state. Some Medicaid programs in states are very forward-thinking and proactive. For example, the Medicaid program in the state of Virginia often refers people for bariatric surgery.

If your primary care doctor says that weight loss surgery is medically necessary, many private insurance companies will pay for it. He or she must also back this up with good medical records and other proof. Most insurance companies need a letter from your weight loss surgeon. Also, your primary care doctor saying why you need to lose weight.

How To Get Qualification For Weight Loss?

A detailed list of the health problems you have because of your weight, including treatment records. High blood pressure, diabetes, heart and blood vessel disease, sleep apnea, gastroesophageal reflux, arthritis, and high cholesterol are some of these conditions. These are:

  • Your medicines right now
  • A detailed look at how being overweight affects your daily life
  • A detailed account of past attempts to lose weight. Several insurance companies now want detailed proof that you are on a diet plan supervised by a doctor. Most ask for at least six months’ worth of office notes from the doctor in charge.
  • History of exercise programs, as well as proof of gym membership

How To Get Coverage From Insurance?

Get letters and records from all the doctors and nurses who have treated you for health problems related to your weight. A lot of insurance companies also want a nutrition consultation and a mental health evaluation. Talk to your doctor about getting a referral for these kinds of visits. Will Medicaid Pay For Weight Loss Surgery

Your chosen surgeon can help you work with your insurance company to get them to pay for your weight loss surgery. The way that each weight loss surgeon’s office handles money and insurance is different. You should be able to talk to someone in the office about your insurance worries and questions. Most of these advisors know what to do and what not to do when working with certain carriers. Dental Insurance That Covers Implants

Also, many doctors who help people lose weight and plastic surgeons offer payment plans. Many practices also know about companies that help pay for medical care and can give you information about them. The surgeon or a member of the staff should be able to answer your questions about how much the treatment will cost and how a payment plan will fit into your budget.

Last Words On Weight Loss Surgery And Health Insurance

If your first attempt to get coverage approved is denied, you can appeal, and you should do so right away. Every insurance company has a way to file an appeal. It is a good idea to get to know the policy of your plan.

Keep in mind that it makes good financial sense for your insurance company to pay for your surgery to lose weight. The upfront costs of weight loss surgery are paid off in three and a half years. This is because weight loss surgery saves money on hospital stays. Also, the cost of diabetes and high blood pressure medicines goes down after weight loss surgery. Many people can stop taking these kinds of medicines for good when their blood sugar and blood pressure go back to normal after they lose weight.

Most insurance companies do not. However, cover body contouring procedures or the costs of diet and exercise plans.

Will Insurance Cover Gastric Sleeve Surgery and All the Associated Costs?


The answer to the question, “will insurance cover gastric sleeve surgery?” depends on your insurance type. If you have private health insurance, they may cover some or all the cost of a gastric sleeve procedure. To inquire an answer to more specific questions like, “does Aetna cover gastric sleeve?” It is best to contact the local office of your insurance provider to confirm if they will cover the cost. The coverage may depend on the insurance company’s state policy in the US.

Additionally, suppose your insurance policy does not cover the costs associated with gastric sleeve surgery. Other options, such as financing through a third-party lender or applying for scholarships, can help offset some costs. Research all available options before deciding on a course of action.


It is also essential to discuss any side effects and potential complications of gastric sleeve surgery with your doctor before making any decisions about this type of procedure. Your doctor can provide more information about what you need to know regarding gastric sleeve surgery, including possible risks and benefits associated with this type of surgery. We hope this article gave you the incentive to search for an answer to “will insurance cover gastric sleeve surgery?”