FAQ

How to get insurance to pay for gastric bypass surgery

For a growing number of patients, weight-loss surgery may offer a way to improve their health and quality of life. Forecasts predict that the bariatric surgery market will grow at a CAGR of 9.56% from 2019 to 2028. And with an average cost of between $15,000 and $36,000, insurance coverage is a important consideration for most patients. You can simplify the insurance process for your surgical patients by learning how to get insurance to pay for bariatric surgery.

Read on to learn which states require insurance plans to cover bariatric surgery and typical insurance criteria for bariatric surgery coverage.

Reading: How to get insurance to pay for gastric bypass surgery

key takeaways

  • most insurances cover bariatric surgery. bariatric surgery coverage is a requirement for all individual, family, and small group insurance policies in 23 states.
    • Most insurers require a BMI of at least 40 (or 35 with comorbidities) for patients to qualify for bariatric surgery coverage.
      • Other typical criteria for demonstrating medical necessity for bariatric surgery include prior weight loss attempts, passing a psychological evaluation, smoking cessation, and no evidence of substance abuse.
      • Does insurance cover bariatric surgery?

        Bariatric surgery can be an expensive procedure, often costing tens of thousands of dollars. in the usa In the US, many insurance plans cover bariatric surgery when a patient meets certain criteria.

        According to a recent survey of coverage criteria for bariatric surgery, 95% of companies have a clearly defined prior authorization policy. all covered en and roux bypass surgery, and most also covered laparoscopic adjustable gastric banding or sleeve gastrectomy.

        Most insurers required a bmis of 40 and above, or 35 and above with a present comorbidity, and a medically supervised weight management (mwm) program prior to approval of bariatric surgery.

        states where insurance is required to cover bariatric surgery

        Under the Affordable Care Act (ACA) Essential Health Benefits (EHB) Benchmark Plans, 23 states require all individual, family, and small group insurance plans to cover bariatric surgery. those states are:

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