Did you know that 68% of health insurance companies cover the weight loss surgery?Many health insurance plans, including Aetna, BCBS (Blue Cross Blue Shield), United Healthcare (UHC), Cigna, Humana, Tri-Care, Champ VA, Medicare and Medicaid cover some or all of the costs of weight loss surgeries such as Gastric Band Surgery (LAP-BAND System® or the REALIZE®Band), Gastric Bypass Surgery, Gastric Sleeve Surgery and other weight loss surgeries for obesity. It must be deemed as a medical necessity by your doctor and must meet the National Institutes of Health requirements for obesity. However, each health insurance plan varies and is plan specific, so it’s important to examine the coverage provided by your plan.
Weight Loss Surgery and Your Health Insurance
We work with your health insurance provider to understand your weight loss coverageInsurance language can be confusing. Let us help you navigate through the confusing language of your benefits with our FREE INSURANCE CHECK. We can check your benefits and find out the insurance requirements necessary for you to get a approval. Pre-approval is almost always required for weight loss surgery.
Ask your insurance the following questions.
It’s complicated but you can read through your benefits brochure, in addition we recommend calling your insurance provider and asking the following questions:
Step 1: Find out if you have insurance coverage for bariatric surgery.Insurance language can be confusing. In addition to reading through your benefits brochure, we recommend calling your insurance provider and asking the following questions:
Is weight loss surgery a covered benefit under my plan?You will need to provide your I.D. number and Group Number, which are found on your insurance card, so keep this information handy. Ask are there any exclusions on my policy for morbid obesity. If no exclusions as present then it most probably is a covered benefit.
What bariatric surgery procedures are covered?
Many insurance companies pay for these weight loss surgery procedures, but you should ask to be sure. If Morbid Obesity is covered or excluded from your specific policy the ICD Code is 278.01
Treatments of Morbid Obesity Include
- Gastric Banding Surgery
- Procedure Code 43770 Laparoscopy, surgical, gastric restrictive procedure)
- Gastric Sleeve Surgery
- (Procedure Code 43775 Laparoscopy, surgical, gastric restrictive procedure: Longitudinal gastrectomy (e.g. sleeve gastrectomy)
- Gastric Bypass Surgery
- (Procedure Code 43644 Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y)(Procedure Code 43645 Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorption)
What is the co-pay amount, if any?
What is the annual deductible, if any, and how much have I met so far?
When does my annual deductible renew?Knowing when your deductible renews can help you reduce your out-of-pocket costs. Here’s how: Let’s say you have already met $875 of your $1,000 annual deductible, and your insurance plan year begins (renews) on August 1. If you have surgery on August 2, you would again be responsible for the $1,000 deductible amount, instead of the remaining $125 from the previous year.
Are there any hospitals or surgeons in the area that you do not contract with?
Knowing the answer can help you select a surgeon who is included in your plan, and help you reduce your out-of-pocket costs.
Step 2: If surgery is covered, work with your bariatric practice to gather all the required documentation for pre-approval.Pre-approval is almost always required for weight loss surgery. It is a way to make sure the procedure is covered under your policy. Typically, your surgeon’s office will submit the required information to your insurance provider to gain pre-approval. Some of the most common bariatric insurance coverage requirements include:
- Body mass index (BMI) greater than 40 or BMI greater than 35 with co morbidities (diabetes, high blood pressure, etc.). To see if you meet these requirements, use our BMI Calculator to see if you qualify
- 18 years of age or older.
- Diagnosis of morbid obesity.
- Participation in a physician-supervised weight loss program for extended time periods (this can vary from 3 to 12 consecutive months, depending on your insurance plan).
- Psychological evaluation prior to surgery. Your bariatric clinic will either provide this service or refer you to a psychologist.
- Documentation of failed diet and exercise plans.
Step 3: Follow up to make sure your insurance company has received your materials.Check in with your bariatric practice to ensure that they submitted your information, or follow up with your insurance company in about a week if you submitted materials yourself. In either case, it doesn’t hurt to contact your insurance directly. You’ll find that patience and persistence can help as you go through this process.
Step 3a: If you are approved, congratulations
Step 3b: If you are denied coverage, don’t be discouraged, and don’t be afraid to contact your provider and ask questions.1. Determine why bariatric surgery is not covered. Ask your insurance provider for specific reasons. 2. Insist on a written denial. 3. Request that your provider reconsider your request. Call the member services phone number listed on your insurance card. You will also need to know your group number, which is also on the insurance card. Request the necessary steps required to file an appeal. 4. File your appeal. You may want to consider working with your bariatric practice to discuss the next steps in appealing for coverage. They can help you navigate the appeal process. 5. Contact your provider to confirm that they have received your appeal. 6. Notify your surgeon’s office after your appeal has been submitted so they can record it in your chart. 7. Follow up with your insurance provider several weeks after filing your appeal.
What to do if your appeal is denied1. If you are denied coverage after you appeal, consider alternative financing options. You may find that bariatric surgery is more affordable than you think. 2. You may want to speak with your employer about getting an individual approval for surgery. They may not know that this is not a covered benefit on the policy they have purchased. Talk to your benefit planner or HR department. 3. Call your state insurance department to register a complaint. Find the number for your state below. Although they may not be able to help with your particular situation, your complaint—along with countless others—may collectively help to change the reimbursement policy.
State insurance departments and phone numbers
Many states are required to have an independent, external board evaluate the validity of denied coverage. This option is available to people in more than 40 states.
|Alabama (205)269-3550||Missouri (314)751-4126|
|Alaska (907)465-2515||Montana (800)332-6148|
|Arizona (602)255-5400||Nebraska (402)471-2201|
|Arkansas (501)686-2900||Nevada (800)992-0900|
|California (800)927-4357||New Hampshire (800)852-3416|
|Colorado (303)894-7499||New Jersey (609)292-5363|
|Connecticut (203)297-3800||New Mexico (505)827-4500|
|Delaware (800)282-8611||New York (800)342-3736|
|District of Columbia (202)727-8002||North Carolina (800)662-7777|
|Florida (800)342-2762||North Dakota (800)247-0560|
|Georgia (404)656-2056||Ohio (800)686-1526|
|Hawaii (808)586-2790||Oklahoma (405)521-1828|
|Idaho (208)334-2250||Oregon (503)378-4271|
|Illinois (217)782-4515||Pennsylvania (717)787-5173|
|Indiana (800)622-4461||Rhode Island (401)277-2223|
|Iowa (515)281-5705||South Carolina (803)737-6117|
|Kansas (800)432-2484||South Dakota (605)773-3563|
|Kentucky (502)564-3630||Tennessee (800)342-4029|
|Louisiana (504)342-5900||Texas (512)463-6464|
|Maine (207)582-8707||Utah (801)530-6400|
|Maryland (800)492-6116||Vermont (802)828-3301|
|Massachusetts (617)727-3357||Virginia (800)552-7945|
|Michigan (517)373-9273||Washington (800)562-6900|
|Minnesota (800)652-9747||West Virginia (800)642-9004|
|Mississippi (601)359-3569||Wisconsin (800)236-8517|
Health Insurance PlansCLICK HERE FOR FULL LIST
Self Pay or Payment PlansPatient’s that do not have insurance, do not meet your specific insurance health requirements, or patient’s that have an exclusion on healthcare policy can take advantage of easy payment plans options for weight loss surgery. Many weight loss surgeons offer payment plans to help manage the cost of your weight loss surgery and have teamed up with medical financing companies. Based on your credit you can qualify for low interest rates and low monthly payments. Many times a instant decision can be determined with a quick over-the-phone application or by filling out an application online.
Contact us at by calling 1.888.875.3383 to get pre-approved through a easy payment plan option for your weight loss procedure like the LAP-BAND®, Gastric Bypass, or Sleeve surgery. Bariatric Bridge or your surgeon’s can be able to answer your questions about treatment costs and fitting a payment plan into your budget.