Weight Loss Surgery with Insurance – Overview
Obesity is one of the most prevalent health disorders affecting adults and children alike in the US.
The Centers for Disease Control and Prevention (CDC) has conducted various extensive studies over the past several decades.
For instance, according to the most recent CDC data, the adult obesity prevalence rate is 41.9%.
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 the leading cause of premature, preventable deaths in the country.
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 US ranges between $20,000-$25,000. The average price of sleeve gastrectomy surgery in the US is around US$ 14,900, while a lap band gastrectomy will cost you around US$ 14,500.
So, before you jump to book an appointment with a gastroenterology specialist, it’s advisable to enquire whether your insurance policy offers coverage for weight loss surgery.
Weight Loss Surgery with Insurance – What is the average cost of Weight Loss Surgery in the US
According to reports, most US patients who undergo weight loss surgery belong to the middle or upper-class strata.
However, most patients suffering from obesity and related issues can’t afford the prohibitive 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.
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 insurance provider will cover the cost of weight loss surgery.
The insurance company has the discretion to provide or reject handling the cost of weight loss surgery.
You will need to read the terms and conditions of your health insurance policy to learn the cost of weight loss surgery and the types of weight loss surgeries covered under it.
Some insurance policies explicitly exclude weight loss surgeries from their list of approved treatments.
Some insurance providers charge more to include weight loss surgery coverage in your insurance policy.
We advise you to contact your health insurance carrier directly to check if your policy covers the cost of weight loss surgery. Their number is usually on the back of your insurance card.
General insurance coverage requirements
- BMI requirements (typically 40+ or 35+ with comorbidities)
- Documentation of failed weight loss attempts
- Psychological evaluation
- Medical necessity documentation
- Pre-surgery dietary counseling
The out-of-pocket costs listed are oversimplified as they can vary significantly based on:
- Individual plan details
- Deductible amounts
- Coverage limitations
- Facility charges
- Geographic location
What Kind of Insurance Policies Cover the Cost of Weight Loss Surgery?
Whether your insurance provider will offer to cover the cost of weight loss surgeries depends on several factors, mainly how you bought your health insurance. For instance,
- Family, Individual, and Small Group Plans (with less than 50 employees), such as Obamacare, require most states to provide coverage for weight loss surgery.
- Large group plans (with more than 50 employees) dictate that it is entirely up to the insurance provider whether they choose to provide coverage for weight loss surgery costs. To clear this, you can enquire with your workplace’s HR department or contact the insurance provider directly.
- Medicaid and Medicare are federal insurance initiatives and offer to cover the cost of weight loss surgeries but coverage varies by state, with some states not covering bariatric surgery. However, you will need to enquire with your choice of bariatric surgeon whether they accept payment for weight loss surgery through Medicare or Medicaid.
The majority of surgeons will help check your insurance benefits without 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, the out-of-pocket cost of undergoing weight loss surgery with insurance coverage comes down to around:
Highly Deductible Plan – US$ 1,901
HMO – US$ 1,475
POS – US$ 2,270
PPO – US$ 2,542
If your health insurance policy does not cover the cost of weight loss surgery and the surgery is not affordable, you can also 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
We advise contacting the insurance carrier to determine if your policy covers weight loss surgery.
You can also contact the HR department if you have insurance provided by your employer.
If your health insurance policy does not cover 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
Follow us