What Insurance Companies Cover Weight Loss Surgery?

What Insurance Companies Cover Weight Loss Surgery – Overview

A person with a body mass index (BMI) of over 40 is termed as being morbidly obese.

Due to the situation’s urgency, such persons might require additional interventions beyond a healthy diet and physical workouts to lose the dangerous excessive weight.

For such an event, the doctor may recommend the patient undergo weight loss bariatric surgery.

However, weight loss surgeries in America cost tens of thousands of dollars, with the rate drastically varying in different states.

Many factors influence the cost of weight loss surgery. Thankfully, major health insurance providers in the country offer to cover the cost of bariatric surgery.

Who Needs to Undergo Weight Loss Surgery?

Not everyone with a BMI over 35 should undergo bariatric weight loss surgery; recommendations depend on additional health conditions and a doctor’s evaluation.

This is an excellent and effective way to lose additional weight and minimize the risk of developing health complications, such as high blood pressure, type 2 diabetes, depression, breathing problems, and even cancer.

The necessity for weight loss surgery is not determined solely by weight but by a combination of factors, including BMI, overall health, and comorbidities.

Apart from this, if you have a family history of obesity or tend to gain weight fast, then bariatric weight loss surgery is highly advised for you.

What Insurance Companies Cover Weight Loss Surgery

Almost every major insurance carrier in the US today covers weight loss bariatric surgery.

However, your specific type of health insurance policy determines whether your insurance provider will cover the cost of weight-loss surgeries.

Some of the common types of health insurance policies in the US that cover the cost of bariatric surgery include:

Medicaid – Although not every surgeon will accept payment from Medicaid, this type of insurance policy offers coverage for weight-loss surgeries.
Medicare – This type of insurance policy covers the cost of bariatric weight-loss surgeries.
Large Group Policy – An employer with 50+ employees under a large group insurance policy can also avail of coverage for weight loss surgery.
Individual/Family/Small Group Policy – Insurance plans covering groups with less than 50 employees may offer to cover the cost of weight-loss surgeries, but this varies by state and specific plan provisions.

5 Insurance Companies Cover Weight Loss Surgery

Let’s take a look at some of the top insurance providers who offer to cover the cost of weight loss surgery for the policyholder in the US:

1 – Aetna

Aetna insurance offers cover for the cost of weight loss surgery for policyholders who fulfill the following criteria:

Adults over 18 years of age
Suffering from morbid obesity and having a BMI of over 40 or more
Having a BMI between 35 and 39.9 and also diagnosed with sleep apnea, medically refractory hypertension, coronary heart disease, and type 2 diabetes.

Aetna health insurance also offers to cover the cost of weight-loss surgeries in adolescents (boys over 15 years and girls over 13 years of age) in case they fulfill the following conditions:

Morbidly obese with a BMI over 40
Clinically diagnosed obstructive sleep apnea
Type 2 diabetes
Pseudo-motor comorbidities

To know if your specific Aetna health insurance policy provides coverage for weight loss surgery, contact the company directly by phone (1-800-872-3862).

2 – Cigna Health Insurance

Cigna Health Insurance is another top-ranking insurance provider offering to cover weight-loss surgery costs.

Policyholders need to fulfill the following criteria to be eligible for weight loss surgery coverage with Cigna health insurance:

Having a BMI of over 40
Having a BMI between 35 and 39.9 with a minimum of one clinically diagnosed obesity-related disorder, including type 2 diabetes, mechanical arthropathy in weight-bearing joints and significant hypertension, coronary heart disease, pulmonary hypertension, obstructive sleep apnea, or venous obstruction

To find out if your particular Cigna Health Insurance policy covers the cost of weight loss surgery, you can contact the company directly by phone (1-800-285-4812).

3 – HealthSpan

HealthSpan is another popular insurance carrier that offers coverage for weight loss bariatric surgeries in the US.

The major criteria that govern this section include the following:

Being morbidly obese with a BMI of over 40, OR
Having a BMI between 35 and 39.9 but suffering from hypertension, diabetes, obstructive sleep apnea, or hyperlipidemia
Possessing documented proof of failed natural dieting attempts to lose excess weight
Diagnosed with the psychological problem associated with being excessively overweight
Those who are pregnant or plan to get pregnant within the next two years from the start of the weight loss program
Non-smoker, or being nicotine-free for at least 3 months

To enquire whether your particular HealthSpan insurance policy covers the cost of weight loss bariatric surgery, you can simply call the company directly by phone (800-686-7100).

4 – Kaiser Permanente

Although Kaiser Permanente offers to cover the cost of bariatric surgeries, several factors decide the approval.

These are the eligibility criteria to get insurance coverage for weight loss surgeries if you have a Kaiser Permanente-sponsored insurance policy:

Being an adult (over 18 years old)
Having a BMI of over 40, OR
Having a BMI between 35 and 39.9 and being diagnosed with type 2 diabetes, sleep apnea, or coronary heart disease
Having participated in a physician-supervised weight loss program for a minimum of 6 months
Having undergone psychological evaluation and agreeing to comply with pre and post-operation procedures

To learn more and confirm whether your specific insurance policy covers weight loss surgery, contact the company representatives using the contact number printed on the back of your insurance card.

5 – Meritus Health

Meritus Health also offers insurance plans that cover the cost of bariatric weight-loss surgeries. To get approval for undergoing weight loss surgery from Meritus, you will need to ensure that you fulfill the following conditions:

Being an adult (over 18 years old)
Being diagnosed as morbidly obese, having a BMI over 40, OR
Having BMI between 35 and 39.9, along with being diagnosed with heart disease, sleep apnea, type 2 diabetes, etc.
Documented history of failed dieting attempts
Showing commitment to medical, exercise, and dietary guidelines as well as follow-up care
Psychological evaluation

To learn more about eligibility criteria and other queries, contact the company directly by phone (301-790-9008). Choosing to pay for weight loss surgery costs without insurance should be carefully considered, as it can be significantly expensive compared to covered procedures.

If you can’t afford it, look at grants for weight loss surgery.

Conclusion

These are just the top 5 popular health insurance providers who offer to cover the cost of weight-loss surgeries in the US.

Contacting the individual insurance provider to confirm the specific details and criteria governing reimbursement for bariatric surgeries is highly advisable.

Grants for Medical