Tips for Working with Your Insurance Company for Bariatric Surgery

The majority of bariatric surgery patients can get a significant amount of their surgery costs covered by an insurance company, but there are several key questions that you need to ask before signing the contract. The average cost of gastric bypass procedures ranges from $18,000 to $22,000, while adjustable gastric banding costs between $17,000 to $30,000. These fees include the cost of anesthesia, doctor’s fees, and in some cases, body contouring procedures after weight loss surgery. Here’s what you need to know when working with an insurance company to cover the cost of weight loss surgery:

Obtaining Insurance Coverage for Weight Loss Surgery

In order to get insurance coverage for weight loss surgery, you will need to start getting documentation from all health care professionals that have helped you manage health conditions such as high blood pressure, diabetes and other health problems related to you being overweight. Some insurance agents will meet with your weight loss surgeon and primary care physician individually to learn more about you and address any concerns or questions.
 
The majority of insurance companies will require the patient to undergo a comprehensive psychological evaluation, and a nutritional consultation.
 
If the insurance provider cannot cover all the costs of weight loss surgery, the patient may be eligible for a payment plan or patient financing from a third party.
 

Questions to Ask the Insurance Company

There are several key questions to ask an insurance provider when making a request for coverage for weight loss surgery. These include:
 
1. What percent of the total bill will I be responsible for?
2. What type of deductible will I need to pay, and when?
3. Does the insurance policy cover morbid obesity?
4. Which hospitals or surgery centers in my local area accept your insurance?
5. Do you offer any type of payment plans or discounts for procedures not covered 100% by the insurance policy?
6. Will the insurance company pay for any plastic surgery procedures after the weight loss procedure? If so, what percentage of the costs will be covered?
7. Are there any waiting periods involved with different types of surgery?
 

Proving Candidacy for Weight Loss Surgery Insurance Coverage

If you are not working with Medicare to cover the cost of your weight loss surgery, you will likely need to work with a private insurance provider that will need a letter from your physician. This letter will state that your weight loss surgery is medically necessary, and your primary care physician will need to cover the following areas:
  • Your height and weight history
  • BMI
  • Obesity-related health conditions (e.g. diabetes, high blood pressure, sleep apnea or heart and blood vessel disease)
  • Description of past dieting efforts that have failed
  • History of exercise programs you have enrolled in
  • Any proof of gym memberships
  • List of medications and nutritional supplements you are taking
Learn more about bariatric surgery in our information guide, or consult with a weight loss surgeon in your area to discuss payment options and find out which expenses may be covered by insurance.
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