What Insurance Companies Cover Weight Loss Surgery – Overview
A person with a body mass index (BMI), or height-to-weight ratio, of over 35 is termed as being morbidly obese.
Due to the urgency of the situation, such persons cannot rely on 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?
Anyone with a BMI of over 35 is recommended to undergo bariatric weight loss surgery.
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.
Simply put, if you weigh over 200 lbs. then you should undergo weight loss surgery if the doctor advises you to.
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 provides cover for 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 – Employees with less than 50 employees covered under a small group insurance plan also offer to cover the cost of weight-loss surgeries in around 23 states within the US.
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, 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, feel free to contact the company directly by phone (1-800-872-3862).
2 – Cigna Health Insurance
Cigna Health Insurance is another top-ranking insurance provider that offers to cover the cost of weight-loss surgeries.
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 different 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 know further details and to confirm whether your specific insurance policy offers coverage for weight loss surgery, you should 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). Weight loss surgery costs without insurance might be a better choice in the long run if you want to avoid a long-term commitment with an insurance company.
If you can’t afford it, take a look at grants for weight loss surgery.
These are just the top 5 popular health insurance providers who offer to cover the cost of weight-loss surgeries in the US.
It is highly advisable to contact the individual insurance provider to confirm the specific details and criteria that govern reimbursement for bariatric surgeries.