Does Insurance Cover Weight Loss Surgery?
Most major health insurance companies do cover weight loss surgeries like gastric bypass or gastric sleeve surgery. However, patients may have to meet certain requirements before insurance will cover the procedures. We have years of experience working with major medical plans and we will help you navigate the process of understanding your benefits and qualifying for weight loss surgery.
For most insurance companies to cover part or all of your weight loss surgery, the following must be true:
You are over 18 years old
You have documented previous weight loss efforts
You are diagnosed with morbid obesity
You can pass a psychological evaluation before surgery
You are not a smoker
You have a documented weight loss plan after surgery
Your BMI is above 40
Your BMI is about 35 with comorbid disease(s)
These requirements will vary based on individual insurance coverage plans. However, since weight loss surgery can significantly turn around your health prognosis, most insurance plans will cover at least a portion of your weight loss surgery. At West Medical, we can help you understand these requirements and assist you in determining your medical insurance benefits.
Insurance companies evaluate the risk vs. benefit analysis for your weight loss surgery. If you can show that you have made several attempts to lose weight and were unsuccessful, it shows determination. It shows the company that you will be committed to maintaining your results after surgery.
Similarly, patients with comorbidities, such as diabetes or hypertension, show a greater potential for health rewards compared to the risks of surgery. Insurance companies will favor the potential benefits if you are likely to suffer from disease without the surgery.