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Obesity is super expensive. According to a 2016 article on Insure.com, obesity costs the United States $117 billion a year on medical expenses and lost productivity. Thankfully, bariatric surgery can be a solution to reduce these expenses. However, some insurance companies aren’t covering weight loss surgery. To find out if yours will cover surgery, it’s up to you to contact your insurance company. Many times when it is covered, you have to meet certain requirements to get approved. Approval time can vary, but you can call at the beginning of your journey to see what your coverage is. Each insurance plan is different, so you’ll need to contact your insurance company to find out if weight loss surgery is covered by insurance.
Is Weight Loss Surgery Covered by Insurance?
Yes, it some cases weight loss surgery is covered by insurance. The information presented in this post is for patients in the United States. Other countries have different rules and requirements, so it may not apply to you. However, even if you are in the United States, I can’t give you a straightforward answer. Several insurance companies will cover weight loss surgery. Something I found in my research for this post is that standard health plans do not cover weight loss surgery. The employer must select weight loss surgery as an option.
So, not only does it depend on your insurance company if weight loss surgery is covered by insurance, but it also depends on the employer from whom you obtain the health insurance. Additionally, you may have to meet certain requirements. Some requirements include a BMI above 35 with documented past weight loss efforts, and have to get several clearances, like a psychological evaluation or a cardiology clearance. Some insurance companies may even require you lose some weight before bariatric surgery. This requirement shows you are committed to the process. Contact your insurance company to find out if weight loss surgery is covered by your insurance.
The Cost of Obesity
It’s a bit alarming to me that bariatric surgery isn’t covered by some insurance companies. I believe every insurance company should cover bariatric surgery for several reasons. First, obesity is expensive. The Insure.com article I referenced earlier stated that obese people spend $395 more on medical care than non-obese people per year. Additionally, obesity increases your risk for several diseases. Some diseases include type II diabetes, high blood pressure, heart disease, obstructive sleep apnea and more. Wouldn’t it make more sense for an insurance company to pony up the cost of bariatric surgery to reduce their member’s overall healthcare costs in their lifetime? Shouldn’t you want healthy members that don’t require a lot of medical care?
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Not only the medical costs, but the cost of obesity in terms of life expectancy is staggering. We all know that insurance companies are out to make a profit. If they are insuring healthy members from whom they collect a premium and not having to pay out as much for the healthcare as obese people, wouldn’t they make more money? The longer their members live, the longer they’re going to pay their premiums to keep their health insurance. It’s in the insurance company’s and employer’s best interest to cover weight loss surgery. After all, healthy employees are productive employees. Bariatric surgery is beneficial not only to the patient but also to the employer and insurance company. Therefore, it should be a standard surgery to cover.
How Long Does Approval for Surgery Take?
Again, this question is one you are going to have to contact your company to see if weight loss surgery is covered by insurance, and if so, what is needed for approval. First, you need to complete all of your weight loss surgery requirements. The approval for surgery can take anywhere from a few days to a few weeks. It’s dependent on several factors. Some factors include when the request was submitted, if all the requirements are met, and how many other requests your company is processing.
RELATED CONTENT: Want to learn the 10 changes you need to make in your life to be successful with bariatric surgery? Get our free download here!
I wish I could tell you straight forward whether your weight loss surgery will be covered by insurance. I wish I knew how long it is going to take for you. However, since every company is different, the only suggestion I can tell you is to contact your insurance company. I did find this interactive tool on Bariatric Surgery Source. It allows you to answer a few simple questions to find out if your insurance covers surgery. You can access this tool by clicking here, and clicking on the purple button to check your insurance.
Speaking Insurance-ese
Hopefully, by now, I’ve beat it into your head that you need to call your health insurance to see if insurance covers weight loss surgery. But you may be wondering what the heck you say to them. Don’t worry, I’ve worked in the medical field and have done some research for you. Duke Health provided some very valuable information for when you speak to your insurance company.
- Find your health insurance card. Call the number on the back of the card for customer service. Follow the prompts to speak to an actual human being.
- Give identifying information to the customer service representative. Explain that you are calling to see if bariatric surgery is a covered benefit.
- Give them the ICD-10 code (medical lingo for a diagnosis code) of E66.01 if your BMI is over 40 or E66.0 if your BMI is unspecified.
- Tell them which bariatric surgery procedure you want and give them the appropriate CPT code (medical lingo for procedure code)
- Gastric Bypass – CPT Code 43644
- Vertical Sleeve Gastrectomy – CPT Code 43775
- Duodenal Switch – CPT Code 43645
- Gastric Band – CPT Code 43770
- What is the covered benefit and how much can you expect to pay out of pocket?
- Do you have any special requirements to get the surgery approved?
- Do you have an incentive program to help pay for the cost of surgery?
- How does it take the insurance company to approve bariatric surgery?
- Is my doctor and hospital covered by the policy?
How Much is Weight Loss Surgery with Insurance?
The Insure.com article I referenced above stated that the average bariatric surgery cost is $17,000 to $26,000 without insurance. Again, your actual out of pocket cost is going to vary. Some factors include if your weight loss surgery is covered by insurance, your deductible, maximum out of pocket, and weight loss surgery requirements. However, don’t fret. Many hospitals will work out a payment plan with you to cover your out-of-pocket costs at a reasonable monthly rate. Call the hospital’s financial counselors to see if you qualify for any charity care and set up a payment plan for your bariatric surgery.
If your insurance company denies your bariatric surgery the first time, try again. The Insure.com article also stated that about 25 percent of bariatric patients are denied the first three times before approval. Be persistent. Involve your family doctor if you need them. Your whole medical team should be working together and doing what is necessary for you to get approval for bariatric surgery. If you need more tips on paying for bariatric surgery, check out this post I wrote about the cost of bariatric surgery.
Getting Your Weight Loss Surgery Covered by Insurance
There is no doubt that bariatric surgery is expensive, however, obesity is more expensive. More insurance companies should cover bariatric surgery because losing weight can extend your life. Each insurance plan is different, so you’ll need to contact your insurance company to find out if weight loss surgery is covered by insurance. It’s worth it to jump through their hoops if it can help save your life. While each insurance company is different, speaking the lingo of the insurance company will help you get the answers you need about bariatric surgery. If you’re denied the first time for your surgery, keep trying. It’s worth all the effort!
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In Summary
In some cases, yes, weight loss surgery is covered by health insurance. However, each health insurance company, as well as the employer from whom you get your coverage, is different. The best thing you can do to find out is to call the number on the back of your member card and speak to a customer service representative to find out for sure.
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