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July 10, 2018 - by Soma Weight Loss - in Health

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Most major insurance companies offer some form of coverage when it comes to weight loss procedures, including gastric bypass, gastric sleeve and lap-bands. While many plans have begun covering these surgeries, it’s important to do your research on which carriers do and do not offer assistance.

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Below, you’ll find a list of carriers and whether or not they cover bariatric surgery, as well as information and advice on how to best work with your insurance company. You’ll need to get preapproved, and you’ll also need to work closely with your health care professionals to minimize your out of pocket expenses as much as possible.

Weight loss procedures and insurance coverage

Insurance providers draw a fine line between bariatric procedures that are included in your coverage and those that are considered elective treatments (not necessary for your health). Typically, insurance companies cover gastric bypass, gastric sleeve, and lap-band procedures.

Other procedures such as gastric balloon are considered to be experimental and, like abdominoplasty (tummy tuck) procedures, are not covered at this time. Some special plans may be exceptions to the rule, and the best way to check is to speak to your insurance agent or human resources officer at your job.

Endoscopic sleeve gastroplasty

  • What is it: Also known as “scarless sleeve”, sections of the stomach are sutured to reduce its’ size during this non-invasive procedure.
  • What does it cost: +/- $10,000-$16,000
  • Coverage: Not usually covered

Gastric balloon

  • What is it: A procedure involving a soft, silicon balloon that is inserted into the stomach to create a sense of fullness and reduce compulsion and desire to eat.
  • What does it cost: +/- $8,000 with or without insurance
  • Coverage: Not usually covered

Gastric bypass

  • What is it: This is one of the oldest weight loss procedures and involves two steps: the separation of the stomach into two sections, and the connecting of the intestines to the smaller stomach section, allowing the stomach to eat less and absorb less calories.
  • What does it cost: +/- $3,500 with insurance; +/- $24,000 without insurance
  • Coverage: Usually covered

Gastric sleeve

  • What is it: This procedure removes a portion of the stomach, creating a new sleeve-like, tube-shaped stomach, also referred to as a “weight loss sleeve.”
  • What does it cost: +/- $3,500 with insurance; +/- $19,000 without insurance
  • Coverage: Usually covered

Lap-band

  • What is it: A lap-band, also known as a laparoscopic adjustable gastric band, is used to tighten and restrict the top portion of the stomach and decrease food consumption.
  • What does it cost: +/- $3,500 with insurance; +/- $15,000 without insurance
  • Coverage: Usually covered

Tummy tuck

  • What is it: Also known as an abdominoplasty, the tummy tuck removes excess, undesirable fat and skin from the abdomen.
  • What does it cost: Between $3,000-$12,000; +/- $5,500 on average
  • Coverage: Not usually covered
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California insurance providers that offer bariatric surgery coverage

How to get approved for Bariatric Surgery

In most cases, insurance companies will have a set of guidelines that allow for preapproval of your intended procedure. This usually includes:

  • A minimum Body Mass Index (BMI) requirement
  • A letter from your physician
  • Proof that you’ve attempted other weight loss methods

Additionally, some insurance providers may require a consultation with a bariatric surgeon and psychological and nutritional evaluations.

Most carriers require patients to be at least 18 years of age or older to be covered for bariatric procedures.

The best way to find out about your policy’s preapproval requirements is to speak with your insurance agent, doctor or surgeon directly. Some policies explicitly exclude weight loss surgery due to the experimental nature of many of the procedures and many insurance companies will charge a premium to include weight loss surgery coverage. Call your insurance agent directly for information about your coverage.

What to do if your insurance provider denies your request

If your desired procedures aren’t covered you’ve still got a few options at your disposal. The first option is to finance the process yourself. You can take out medical loans, and your doctor may be able to assist you in finding financial institutions that he or she has previously worked with. Additionally, you are allowed to make changes to your insurance at least once a year (sometimes more with qualifying life events).

If your current coverage doesn’t cover your bariatric treatment, spend time looking into policies that do cover your intended procedures, and work to make a policy change when the time comes. If your insurance is offered by your employer and doesn’t seem to offer the benefits that you’re looking for, consider finding your own insurer or a new employer with better benefits.

Talk to your doctor and maintain a healthy relationship with the health care professionals that are assisting you. This will make it easier for you to obtain physician letters, consultations, and advice from individuals who work with insurance companies daily. They have intimate knowledge of what can and cannot be approved.

Tips for working with your insurance company

In order to get the best experience and most out of your coverage, it’ll help to have all of your information readily available when you’re working with your insurance agent or medical professionals. If you’ve built a relationship with your doctors, and those doctors have relationships with your insurance company, it’ll ensure a smooth process and increase the likelihood that you will be approved in a timely manner (assuming your plan includes appropriate coverage).

The first task that lies ahead of you is to talk to your insurance company. Whether it’s your agent or the toll-free number, get ahold of someone who can speak directly to your coverage and what is and is not included. Talk to your doctor and speak with potential surgeons; Make sure you speak with more than one health care professional.

Building relationships with your health care professionals will make it easier to secure help and second opinions as well as verify that the right treatment is being recommended so that you can get the treatment you’re looking for and minimize your out-of-pocket expenses.

Soma Weight Loss works with most insurance carriers and offers patient payment plans.

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