Will Your Insurance Cover Bariatric Surgery and Other Weight Loss Procedures?
Sure, bariatric surgery can help you lose your excess weight, gain more energy to be active, and give you the courage to try a super green smoothie. But let’s be honest, the healthy life that awaits you post-weight loss surgery isn’t what’s holding you back from a consultation with a bariatric surgeon in your area. If you’re like many potential patients, you just don’t know if weight loss surgery is really in in your budget. You may be asking yourself:
How can I afford weight loss surgery?
Will my health insurance cover my bariatric procedure?
Can I pay for weight loss surgery on my own?
While your medical insurance may cover your weight loss procedure, if you don’t have insurance or you’re not approved for bariatric surgery through your insurance provider, there are other options. Let’s start discussing all of the options you have today (besides winning the lottery).
There’s no one-price-fits-all tag when it comes to bariatric surgery.
There are several factors that go into calculating the cost of your weight loss procedure, such as the specific type of bariatric surgery, the practice location, and your unique medical needs.
You’ll also want to include additional fees, such as anesthesia costs, medical tests, and post-op prescriptions in your financial calculations as well.
If you’re looking for an accurate figure to budget for, scheduling a consultation with a doctor is your best bet. Your initial consult will always be one-on-one with Dr. Bo or Dr. Bleu. The first appointment is all about your options and putting together a plan for your specific goals. Many insurance plans will cover that initial appointment.
Let’s talk about your options for paying the expected costs of your bariatric procedure, starting with the most popular (and obvious) choice: health insurance.
Will Insurance Cover Bariatric Surgery?
Many insurance companies now cover weight loss surgery, but they don’t always provide coverage for every procedure.
For example, many plans will pay for gastric sleeve surgery and duodenal switch surgery, but they will not pay for the ORBERA Balloon, a non-surgical weight loss procedure.
Request a free insurance check online or call our office and we will work with your insurance company to determine benefits.
Additionally, even though certain insurers cover weight loss surgery, your specific plan may not.
Our experienced team at Panhandle Weight Loss Center can contact your insurance provider on your behalf to ask about your plan’s specific coverage details once you have scheduled a consultation. Since our staff know all the ins-and-outs of the insurance approval process, they’ll help speed up the process.
How to Get Coverage for Bariatric Surgery
In addition to only approving coverage for certain procedures, each insurance company has its own medical criteria that you’ll need to meet before you are given the green light for bariatric surgery.
You’ll need to prove that you’re a solid candidate for your chosen weight loss procedure (which could take three months or even up to a year).
They’ll be looking for the “medical necessity” of your surgery, so you’ll generally need to:
1. HAVE A MINIMUM BODY MASS INDEX (BMI) CONFIRMED BY YOUR DOCTOR OF:
- 40 or above
- 35 or above with one or more weight-related medical condition, such as:
- Type 2 diabetes
- Coronary heart disease
- High blood pressure
- Severe Obstructive sleep apnea
- … etc.
To find your BMI, use this easy BMI calculator here.
2. COMPLETE A MEDICALLY SUPERVISED WEIGHT LOSS PROGRAM
Depending on your insurance provider’s requirements, this could last anywhere from 3–12 consecutive months.
You can see what this entails by checking out our medically supervised weight loss program here at PWLC.
3. SCHEDULE CONSULTATIONS AND OBTAIN REQUIRED PAPERWORK
You’ll need to meet with a team of healthcare professionals to recommend weight loss surgery to your insurance company.
Anticipate appointments with your:
- Bariatric surgeon for an overall assessment
- Primary care physician for a medical clearance letter declaring you fit for surgery or a letter of medical necessity if you’re morbidly obese
- Mental health professional to obtain a psychiatric evaluation and a mental health clearance letter
- Registered dietician for a nutritional evaluation and post-op eating advice
4. WAIT FOR YOUR HEALTH INSURANCE TO REVIEW YOUR CASE
When you have all these letters, you’ll need to send them to your insurance company for approval.
They may ask for additional proof of your obesity-related health conditions so make sure to send a detailed history of your struggles and previous attempts to solve them, such as gym memberships and FDA-approved weight loss supplements.
Your insurance company will review all of this information before issuing you an approval or denial letter (generally within a month).
- Approved applicants will be able to schedule their surgery.
- Denied applicants can appeal their insurance’s company’s decision by writing an appeal letter.
We know what’s usually required of your insurance company here at PWLC so we can help you take care of many of these bariatric coverage pre-approval steps in-house.
We offer our patients exercise training, a medically-supervised weight loss program, and a one-hour class with our registered dietitian for nutritional counseling and answers for all your post-op diet questions.
But what happens if you don’t qualify for insurance coverage?
Financing Your Bariatric Surgery: Easier Than You May Think
If you don’t have insurance coverage and you don’t have enough to pay for your entire surgery with cash hidden under your mattress, there are a few financing options you should consider, such as:
1. PROSPER HEALTHCARE LENDING
As the premier financing company in the healthcare industry, more than 250,000 patients have borrowed over $5 billion for their medical procedures from Prosper Healthcare Lending.
When you go with a Prosper loan, you’ll have:
- An immediate decision about your loan approval without a negative impact on your credit score—often in less than 2 minutes!
- Longer payment terms for lower monthly payments
- No collateral required
- No prepayment penalties
- A 100% confidential and secure transaction
Your loan money will be directly deposited in your bank account and you’ll be able to pay for your bariatric surgery ASAP. Check to see how much you’ll be approved for today.
The CareCredit credit card can be used to cover your weight loss surgery expenses whether you have insurance or not.
Use it to supplement your insurance and pay high deductibles and copays—or use it without insurance to cover the costs of your entire bariatric procedure.
You can apply online and find out immediately if you’re approved for a line of credit to pay for your weight loss surgery.
SHOULD YOU CONSIDER ADDING BLIS INSURANCE?
Patients going the self-pay route have the option of adding BLIS Insurance to help cover the cost of possible complications relating to their procedure.
Dr. Bo and Dr. Bleu are 2 of only 12 bariatric surgeons in the state of Texas who are approved to offer BLIS Insurance to their patients.
Click here to learn more about BLIS and what a BLIS protection plan covers for you.
The Bottom Line When it Comes to Price and Your Bariatric Surgery
When you think about all the money you’re spending being overweight or obese, it may start to put the cost of bariatric surgery in perspective.
After all, you’ll no longer have to spend all that money on your prescriptions and doctors’ visits managing your obesity-related medical conditions post-bariatric surgery.
Instead of subtracting years from your life remaining at your body’s set point, find out the real cost of pressing the reset button on your body with weight loss surgery.
Schedule a consultation at Panhandle Weight Loss Center and we’ll help you crunch the numbers so that your weight loss journey is easy, uncomplicated, and the best decision of your life.