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Will Insurance Cover Bariatric Surgery?

Will Insurance Cover Bariatric Surgery?

Bariatric surgery is usually only an option for people who are significantly obese and have been unable to lose weight through diet and exercise alone.

Are you considering bariatric surgery to achieve your weight loss goals, but wondering whether insurance will cover the cost? You’re not alone! Bariatric surgery can be a life-changing procedure, but navigating through insurance policies and coverage options can be overwhelming. In this blog post, we’ll delve into the question on everyone’s mind: Will insurance cover bariatric surgery? Read on to find out everything you need to know before taking the plunge!

Introduction to Bariatric Surgery

Bariatric surgery is a term used for a variety of weight loss surgeries. The most common types are gastric banding, gastric bypass and sleeve gastrectomy. Bariatric surgery is usually only an option for people who are significantly obese and have been unable to lose weight through diet and exercise alone.

There are several things to consider before undergoing bariatric surgery, such as whether or not you are eligible for the procedure and if your insurance will cover it. This article will provide an introduction to bariatric surgery and help you understand the process involved in determining coverage from insurance companies.

Types of Bariatric Surgeries

There are a few different types of bariatric surgery, and they each come with their own set of pros and cons. The most common bariatric surgeries are gastric bypass, sleeve gastrectomy, and adjustable gastric banding.

Gastric bypass is one of the most common bariatric surgeries. It involves creating a small pouch at the top of the stomach and attaching it directly to the small intestine. This allows food to bypass a large portion of the stomach, which reduces the amount of calories and nutrients that are absorbed. Gastric bypass surgery can be done laparoscopically or as an open surgery.

Sleeve gastrectomy is another common type of bariatric surgery. It involves removing a large portion of the stomach, leaving only a small sleeve-shaped section. This restricts the amount of food that can be eaten and also reduces the amount of calories and nutrients that are absorbed. Sleeve gastrectomy surgery is typically done laparoscopically, but can also be done as an open surgery.

Adjustable gastric banding is a less common type of bariatric surgery. It involves placing a band around the upper part of the stomach to create a small pouch. This pouch can then be adjusted to allow more or less food into the stomach, depending on the individual’s needs. Adjustable gastric banding surgery is typically done laparoscopically, but can also be done as an open surgery.

Qualifying Criteria for Coverage

In order to qualify for insurance coverage of bariatric surgery, patients must typically meet the following criteria:

-A body mass index (BMI) of 40 or higher, or a BMI of 35 or higher with one or more obesity-related health conditions.

-Attempted but failed to lose weight through other means, such as diet and exercise.

-Provide evidence that their weight is negatively impacting their health.

-Be able to commit to making lifestyle changes after surgery.

Common Insurance Providers and Their Approaches to Covering Bariatric Surgery

There are a number of common insurance providers in the United States, and each one has their own approach to covering bariatric surgery. Some insurance companies will cover the surgery if it is deemed medically necessary, while others will only cover it if the patient has a body mass index (BMI) of 40 or higher. Still other insurance providers will only cover the surgery if the patient has a BMI of 50 or higher.

It is important to check with your particular insurance provider to see what their policies are regarding bariatric surgery coverage. Many times, patients who are seeking bariatric surgery will need to get pre-authorization from their insurance company before the surgery can be scheduled. This process can be time consuming, so it is important to start the process as soon as possible.

Some common insurance providers and their approaches to covering bariatric surgery are outlined below:

Aetna: Aetna covers bariatric surgery if it is determined to be medically necessary. The company requires that patients have a BMI of 35 or higher and have tried other weight loss methods without success before they will approve coverage for bariatric surgery.

Blue Cross Blue Shield: Blue Cross Blue Shield plans vary in terms of coverage for bariatric surgery. Some plans will cover the surgery if it is medically necessary, while others require that the patient has a BMI of 40 or higher. Check with your particular plan to see what the requirements are for coverage.

Understanding Deductibles and Co-Insurance

Undergoing any kind of surgery is a big decision—one that usually isn’t made lightly. But if you’re considering bariatric surgery to improve your health, it’s important to know that the procedure may be covered by insurance.

Most insurance plans—including Medicare and Medicaid—now recognize obesity as a disease that requires treatment. As such, they may cover bariatric surgery if you meet certain criteria, such as having a body mass index (BMI) of 40 or higher, or a BMI of 35 or higher with one or more obesity-related health conditions.

If your insurance plan does cover bariatric surgery, you will likely be responsible for paying a deductible, co-insurance, and/or co-payments. Deductibles are the amount you must pay out-of-pocket before your insurance company begins to pay its share. Co-insurance is your share of the costs of a covered medical service, and is usually calculated as a percentage of the allowed amount for the service. For example, if your plan’s allows $100 for a particular office visit and you have 20% co-insurance, you would be responsible for paying $20 while your insurance company would cover the remaining $80. Co-payments are set amounts that you pay for specific medical services, such as office visits or prescriptions.

It’s important to check with your insurer in advance to see what coverage exists for bariatric surgery and what you will be responsible for paying. Knowing this information before you proceed with the surgery can help you plan for the financial aspects of the process and avoid any surprises related to what your insurance will or won’t cover.

Impact of Health Savings Accounts

“Health savings accounts are a great way to save for medical expenses, but there are some things to consider before you open one. Here are a few things to keep in mind when deciding if a health savings account is right for you.”

1. Tax Benefits: Money deposited into a health savings account (HSA) is tax-free, and any money used to pay for qualified medical expenses is also tax-free. This can provide some nice savings if you have a significant amount of medical expenses each year.

2. Lower Health Insurance Premiums: By contributing to an HSA, you are essentially pre-paying your medical expenses, which can enable you to purchase lower cost health insurance in the long run since more of your healthcare costs will be covered by the HSA funds rather than out-of-pocket or with an insurance company premium increase.

3. Investment Options: Depending on the chosen institution, some HSAs come with unique investment options that provide additional growth potential beyond saving money for immediate use. With more assets allocated towards investments, the value of the account could grow faster over time as opposed to just regular savings accounts with no additional return on capital.

4. Enrollment Deadlines: Some HSAs restrict when you can enroll or switch contributions levels depending on when certain plans are offered throughout the year or if there is an open enrollment period in place for their particular plan option. Make sure that you understand these restrictions if they apply to you.

5. Account Portability: Even if you switch health insurance providers or employers, your HSA is typically portable and you’ll still be able to access the funds that are stored within it. This makes HSAs a great option for those who are looking for savings options that follow them through different stages of life.

Overall, HSAs provide numerous tax and investment benefits to their holders, as well as other unique financial opportunities. However, it is important to understand the rules associated with these accounts before making a decision so that you can decide if opening up one of these accounts will work best for your personal situation.

 

Finally, we hope that this article on insurance coverage for bariatric surgery has been useful in helping you understand what your options are and how you could go about getting the coverage you may need. While deciding to undergo weight-loss surgery is a big decision and not one to be taken lightly, rest assured knowing that with the right research and preparation it should ultimately pay off. Good luck on your journey!