Weight Loss Surgery With Insurance

Weight Loss Surgery with Insurance – Overview

Obesity is one of the most prevalent health disorders affecting adults and children alike in the US.

Various extensive studies have been conducted by the Centers for Disease Control and Prevention (CDC) in the past several decades.

For instance, the U.S. adult obesity prevalence rate was about 40.3% in 2021–2023, with the severe obesity rate rising to 9.7% by 2021–2023 (up from roughly 4.7% in 1999–2000). (1)

Persons suffering from obesity are known to develop one or more serious health disorders, such as stroke, heart disease, type 2 diabetes and some forms of cancer.

Obesity has become a leading cause of premature, preventable death in the U.S., second only to tobacco use. (2)

Thanks to advances in gastric science, it is possible to treat obesity effectively. However, the cost of obesity surgery in the US is still considerably expensive.

Hence, many people suffering from obesity wonder whether their insurance will cover weight loss surgery.

Let’s find out.

What is the Average Cost of Weight Loss Surgery in the US?

The average cost of gastric bypass surgery in the U.S. is around $20,000 to $30,000 as of 2024. (3) The average cost of sleeve gastrectomy surgery in the U.S. is about $17,000–$26,000, while a lap band gastrectomy costs roughly $17,000–$30,000. (4)

So, before you jump to book yourself an appointment with a gastroenterology specialist, it’s advisable to enquire whether your insurance policy offers cover for weight loss surgery or not.

According to reports, the majority of patients who undergo weight loss surgery in the US belong to the middle or upper-class strata.

However, most patients suffering from obesity and related issues can’t afford the extremely expensive cost of a weight-loss surgical treatment. This is where insurance companies come in handy.

Will My Insurance Provider Cover the Cost of Weight Loss Surgery?

Whether your insurance company covers the cost of weight loss surgery depends on various factors.

As a rule, insurance companies do not cover truly experimental weight-loss procedures; however, standard surgeries like duodenal switch, gastric sleeve, gastric banding, and one-anastomosis “mini” gastric bypass are now generally accepted and often covered by insurance (when medical criteria are met). (5)

However, it is more likely that your insurance provider will include cover for the cost of laparoscopic gastric bypass, gastric sleeve and lap gastric band surgeries.

Still, this does not necessarily mean that your particular insurance provider will cover the cost of weight loss surgery.

The insurance company has the discretion to provide or reject coverage for the cost of weight loss surgery.

You will need to read the terms and conditions of your health insurance policy to know the cost of weight loss surgery and the type of weight loss surgeries that are covered under it.

Some insurance policies explicitly exclude weight loss surgeries from their list of approved treatments.

Some insurance providers tend to charge more to include weight loss surgery coverage in your insurance policy.

The best way to check if your health insurance policy offers coverage for the cost of weight loss surgery is to contact your carrier directly. You can find their number usually on the back of your insurance card.

What Kind of Insurance Policies Cover the Cost of Weight Loss Surgery?

The fact of whether your insurance provider will offer to cover the cost of weight loss surgeries depends on several factors, mainly on how you bought your health insurance. For instance,

• In many states, individual, family, and small-group plans under the Affordable Care Act (Obamacare) are required to cover weight loss surgery as an essential health benefit, provided the state mandates it.
• For large-group employer plans (more than 50 employees), coverage for weight loss surgery is optional and depends on whether the employer’s plan includes it, since these plans are not mandated to cover bariatric surgery. To clear this, you can enquire with your workplace’s HR department or contact the insurance provider directly.
• Medicare does cover certain weight loss surgeries (such as gastric bypass and laparoscopic banding) for qualifying patients and the vast majority of state Medicaid programs (49 out of 51) now include coverage for one or more bariatric procedures, though specific criteria vary by state. However, you will need to enquire with your choice of bariatric surgeon whether they accept payment for weight loss surgery through Medicare or Medicaid.

Most surgeons will help verify your insurance benefits at no additional cost.

These checks can be done quickly through the surgeon’s office. Hence, it is highly advisable to contact your local surgeon and request them to check the benefits of your insurance policy.

On average, patients with insurance can expect to pay roughly $3,000 to $4,600 out-of-pocket for weight loss surgery, depending on their deductibles and plan coinsurance – for example, if insurance covers about 80% of the cost. (6)

Highly Deductible Plan – $1,901

HMO – $1,475

POS – $2,270

PPO – $2,542

In case your health insurance policy does not cover the cost of weight loss surgery and the cost of the surgery is not affordable, then you can also choose to apply for a medical loan.

Numerous companies tie up with weight loss programs to offer loans to patients who want to undergo weight-loss surgeries to improve their overall health by preventing severe disorders and complications from being obese.

Conclusion

To know if your insurance policy offers coverage for weight loss surgery, we advise you to contact the insurance carrier directly.

You can also contact the HR department if you have insurance provided by your employer.

In case your health insurance policy does not include coverage for weight loss surgery, you can even apply for a medical loan or grant.

Reference links:-

https://www.cdc.gov/obesity/data/adult.html

https://www.webmd.com/diet/obesity/

See Also

What is Social Health Insurance

What is HHS

What is NIH