Which Plans Provide Bariatric Surgery Insurance Coverage?

Most health insurance providers have coverage for weight loss surgery in some form. The challenge is really to find a health insurance plan or policy that includes coverage for the specific bariatric surgery procedures you need. If you currently have health insurance coverage under one of the following types of health insurance plans you may already have coverage for some or all of the procedures that you need.

Bariatric Insurance Coverage by Medicare

Medicare will now pay for weight loss surgery including laparoscopic adjustable gastric banding, open and laparoscopic biliopancreatic diversions, as well as the Roux-en-Y bypass. If you are 65 or older, Medicare eligible and meet certain BMI requirements, this is your best bet for obtaining bariatric health insurance coverage. No special pre authorization is needed however all patients must be treated in specialized facilities designated as Centers of Excellence or Level 1 Bariatric Surgery Centers.

Bariatric Insurance Coverage by Medicaid

Insurance coverage for bariatric surgery procedures by Medicaid fluctuates depending on the state where you live. The state of Virginia has a Medicaid program that often covers patients for bariatric surgery and the state of Oregon recently added bariatric surgery to its list of covered procedures. Other states may also cover bariatric surgery for patients that are able to document that they meet the requirements of the National Institute of Health (NIH) and have exhausted all other options.

Bariatric Surgery Coverage Influenced by Employers

In companies with greater than one thousand employees, the employer can make or at least influence decisions about benefits, including bariatric surgery insurance coverage. Companies with fewer than one hundred employees generally do not provide insurance coverage for bariatric surgery. The best way to know whether or not you have bariatric surgery insurance coverage is to check with the benefits administrator, who is usually part of the human resources department of your company.

Bariatric Surgery Insurance Coverage by Private Insurance Companies

The approval process to obtain bariatric surgery insurance coverage can be more complicated for private insurance companies. In most cases, your surgeon will require that authorization be submitted and approved before your surgery can be scheduled. The process will involve gathering documentation that you meet the requirements and in cases where authorization is denied and you need to appeal, your surgery can be delayed.

Exceptions to the Rule

Many health insurance plans and policies that do provide full or partial coverage for bariatric surgery may not provide coverage for other procedures such as body contouring, liposuction, face lifts or breast lifts and augmentations you may need after extreme weight loss, even if medically supported by your doctor. Check with your specific provider, your employer and your actual policy when planning these types of procedures to be certain of coverage and avoid any surprises.

If you do not already have bariatric surgery insurance coverage in your policy and have already started treatment for an obesity condition, you may have trouble being able to obtain a new policy with this type of coverage due to pre existing condition clauses.