Bariatric Surgery Insurance – some answers

Posted on July 4, 2014 at 11:56 PM by Todd Eibes, MD

Bariatric surgery insurance should be at the top of your list when you are considering your options for weight loss surgery.

Most insurance companies recognize that people who are obese are more likely to get serious health conditions such as high blood pressure, heart disease, type 2 diabetes, high cholesterol, and sleep apnea, among about 25 others. Does your insurance company provide bariatric surgery insurance?

Although many insurance companies now offer coverage for weight loss surgery, policies can vary by state and provider.

Qualifying for bariatric surgery insurance will likely require documentation from both your weight loss surgeon and your primary care physician, including:

A determination from your primary care physician that the surgery is medically necessary
Your height and weight history, including your BMI
A detailed description of how the obesity affects your daily activities
A detailed description of your obesity-related health conditions, such as diabetes, sleep apnea, high blood pressure, heart disease, gastro-esophageal reflux, high cholesterol, and arthritis
Any medications you are currently taking
A detailed documentation of participation in a physician-supervised diet program. (Most companies require at least six months when considering bariatric surgery coverage.)
A history of exercise programs, which can include health care membership or training program

Many insurers also require psychological and nutritional evaluations, which will be included as be part of your Iowa Weight Loss Specialists pre-surgery process.

These are to make sure that you understand how the bariatric surgery will impact your lifestyle, ensure you have no eating disorders or other psychological issues, and help outline specific dietary changes and behavioral habits you’ll need to make after your weight loss surgery.

Medicare, the U.S. government health plan for people 65 or older, has covered/included the gastric sleeve surgery for over two years.

Although Medicare does not require a pre-authorization before bariatric surgery, unlike traditional insurance companies, it does typically requires candidates to participate in a six-month medically supervised weight loss program through their primary care physician before coverage will be approved.

Your local Medicare provider will be able to give you a list of other requirements. Medicaid, the federal government's health care plan for certain low-income individuals and families, also varies in coverage from state to state.

If all of these insurance hurdles seem overwhelming, don’t worry. Dr. Eibes’ team is committed to make this process as easy as possible. As part of your program at the Iowa Weight Loss Specialists you’ll be assigned a financial counselor to help guide you through the sometimes challenging insurance process. We’ll do everything we can to help you gain the insurance approvals you need.

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