Bariatric Surgery & Weight Loss Coverage

“More than one-third of U.S adults are obese with a Body Mass Index (BMI) of 30 or higher,” according to the Centers for Disease Control and Prevention (CDC). Obesity is a serious health concern that has a negative impact on one’s well-being and can lead to other health issues such as Type 2 diabetes, high blood pressure, sleep apnea, and heart disease. Weight loss surgeries, also known as Bariatric surgeries, are a common treatment for individuals who struggle with their weight. However, these surgeries can be expensive and many people do not know if their health insurance covers them. Here is what you need to know about Bariatric Surgery & Weight Loss Coverage.”

What is Bariatric Surgery?

Bariatric surgery is a type of surgery that aims to help people lose weight by making changes to their digestive system. The surgery involves making the stomach smaller, which means you will feel full sooner and eat less. Some types of Bariatric Surgery also involve bypassing part of the small intestine to limit the amount of food your body can absorb. Bariatric surgery is often used as a last resort for people who struggle with their weight and have not had success with diet and exercise alone.

Bariatric surgery has proven to be an effective treatment for obesity. According to the American Society for Metabolic and Bariatric Surgery (ASMBS), people who have Bariatric Surgery lose an average of 60% of their excess weight within the first two years of the procedure. They also have significant improvements in their overall health, including a reduction in Type 2 diabetes, high blood pressure, and sleep apnea.

What Does Bariatric Surgery Coverage Depend On?

Whether Bariatric Surgery is covered by your health insurance depends on several factors. One of the primary factors is the type of health insurance plan you have. If you have an employer-sponsored health plan, the coverage for Bariatric Surgery will depend on what the employer has chosen to include in the plan. If you have a plan through the Health Insurance Marketplace or Medicaid, the coverage for Bariatric Surgery may also vary.

Another factor that can impact Bariatric Surgery coverage is the reason for the surgery. Insurance companies typically only cover Bariatric Surgery if it is considered medically necessary. This means that if you are considering Bariatric Surgery for cosmetic reasons, you will likely have to pay for it out of pocket.

What is defined as medically necessary?

Insurance companies use different criteria to determine whether Bariatric Surgery is medically necessary. Generally, they will look at your BMI, any health conditions you have that are related to your weight, and whether you have attempted other weight loss methods without success. Your doctor can help you determine whether you meet the insurance company’s criteria for medically necessary Bariatric Surgery.

Does Health Insurance Cover Bariatric Surgery?

The answer depends on your specific health insurance plan. Some plans do cover Bariatric Surgery while others do not. Even within a specific insurance company, different plans may have different coverage options. It is important to review your plan’s coverage options and speak with your insurance company if you are unsure.

Additionally, it is essential to keep in mind that while Bariatric Surgery is covered under some insurance plans, there may be certain requirements that you will need to meet before your insurance company will provide coverage. These requirements can include participating in a weight loss program for a specific amount of time or having a certain BMI.

Who pays for Bariatric Surgery?

Even if your health insurance covers Bariatric Surgery, you may still be responsible for paying some of the costs. This could be in the form of co-pays, deductibles, or coinsurance. It is important to understand your financial responsibility before undergoing the surgery.

What are the Benefits of Using a Health Insurance Expert?

The world of health insurance can be complicated and confusing. It can be difficult to determine what is covered and what is not, and how much you will be responsible for paying. That is why it is essential to use a health insurance expert to help guide you through the process.

Health insurance experts can help you understand your coverage options and any potential costs associated with Bariatric Surgery. They can also help you navigate the insurance company’s requirements for coverage, such as pre-authorization or medical necessity.

Using a health insurance expert can save you time and money in the long run. They can help you find the best coverage options for your specific needs and budget, ensuring that you are not overpaying for insurance that does not provide adequate coverage for Bariatric Surgery.

How Can US Health Insurance Options LLC Help?

At US Health Insurance Options LLC, our licensed agents are experts in health insurance coverage. We can help you understand your coverage options for Bariatric Surgery and any potential costs you may be responsible for. We work with a variety of insurance companies to help you find the best coverage options for your specific needs and budget.

Contact us today to speak with one of our licensed agents and get started on finding the best health insurance coverage for your needs.

Resources

• Bariatric Surgery & Weight Loss Coverage
• Florida Medicaid
• Florida Medicare