Bariatric surgery insurance coverage varies by insurance policy. If your policy covers weight loss surgery and you meet the qualifying requirements, most plans will pay for gastric sleeve, gastric bypass, gastric band, or duodenal switch surgery.
Your insurance costs can be as low as $0, depending on your policy. however, most insurance plans require the patient to pay part of the costs in the form of copays, deductibles, and coinsurance.
Please read and click below for additional details on weight loss surgery insurance.
index
click on any of the topics below to go directly to that section
- coverage by plan type
- covered procedures
- get approval
- find a weight loss surgeon
- arizona
- california
- red
- delaware
- hawaii
- illinois
- iowa
- main
- maryland
- massachusetts
- michigan
- snowfall
- new hampshire
- new jersey
- new mexico
- new york
- north carolina
- north dakota
- rhode island
- south dakota
- vermont
- west virginia
- wyoming
- Option 1 (recommended): Your local surgeon will contact your insurance company to confirm your free benefits (even if you don’t go ahead with surgery) . Your office will be very familiar with your insurance company’s requirements and approval process, so it’s usually a good idea to let them do the work for you. click here to find a local surgeon.
- option 2: contact your insurance company and/or check the summary plan description (spd). See our page on Insurance Covering Bariatric Surgery for a complete list of insurance companies in the United States, contact information, and bariatric surgery coverage requirements.
- Option 1 (recommended): Your local surgeon will contact your insurance company to determine the details of your coverage at no charge (even if you decide not to have surgery). Your office has been through the approval process with your insurance company many times, so let them work on your behalf to make the process as smooth as possible. click here to find a local surgeon.
- option 2: ask your human resources (hr) department whether or not weight loss surgery is a benefit included in your plan.
- option 3: contact your insurance company and/or check the summary plan description (spd). Click here for a complete list of US insurance carriers, contact information, and coverage criteria for bariatric surgery.
- Option 1 (recommended): Your local surgeon will contact your insurance company to confirm your free benefits. Your office will be very familiar with your insurance company’s requirements and approval process, so it’s usually a good idea to let them do the work for you. click here to find a local surgeon.
- option 2: ask your human resources (hr) department whether or not weight loss surgery is a benefit included in your plan.
- option 3: contact your insurance company and/or check the summary plan description (spd). Click here for a complete list of US insurance carriers, contact information, and bariatric surgery coverage policy details.
- a body mass index (BMI) greater than 35
- at least one comorbidity (health problem) related to obesity
- must have documentation in your medical records confirming that previous attempts at medical treatment for obesity have been unsuccessful
- gastric sleeve surgery (laparoscopic only)
- gastric bypass surgery (open or laparoscopic)
- gastric band surgery (laparoscopic only)
- biliopancreatic diversion with duodenal switch (bpd/ds) (open or laparoscopic)
- gastric sleeve surgery
- gastric bypass surgery
- gastric band surgery (gastric band surgery)
- duodenal switch surgery
- gastric balloon
- aspireassist
- experimental procedures
- Minimum body mass index (BMI) to be confirmed by your doctor:
- BMI greater than 40 -o-
- bmi greater than 35 with one or more of the following:
- clinically significant obstructive sleep apnea
- coronary heart disease
- medically refractory hypertension
- type 2 diabetes mellitus
- complete a medically supervised diet program. bariatric surgery insurance criteria for program duration range from 3 to 7 consecutive months.
- Schedule a consultation with your bariatric surgeon.
- Schedule an appointment with your primary care physician to obtain a medical clearance letter.
- schedule a psychiatric evaluation to obtain a mental health clearance letter.
- schedule a nutritional assessment from a registered dietitian.
- Send all of the above documentation to your insurance company along with a detailed history of your obesity-related health problems, difficulties, and treatment attempts. the review process usually occurs in less than a month.
- Insurance company sends an approval or denial letter:
- If approved, your surgeon’s bariatric coordinator will contact you to schedule an appointment.
- If you are denied, you may choose to appeal the denial.
Your surgeon’s office will be highly experienced in managing the above process and may have all the necessary staff (eg, registered dietitian, psychiatrist, bariatric coordinator, etc.).
click here to access the directory of weight loss surgeons to get started. most offices will verify your insurance for free to confirm coverage criteria.
find a weight loss surgeon
insurance coverage by plan type & state
Before looking up your insurance company’s specific coverage requirements for weight loss surgery, you should find out if your specific policy covers them. review the following plan types for more information:
individual or family insurance
Due to the passage of the Affordable Care Act (Obamacare), insurance companies in 23 states must cover weight loss surgery for all individual plans, family plans, and small group plans (employers with less than 50 full-time employees). The updated list below includes all Affordable Care Act weight loss surgery states.
obamacare weight loss surgery statuses (for individual, family and small group plans)
To confirm your coverage, you have a couple of options:
If you discover that weight loss surgery is not covered, you still have several options for financing bariatric surgery to make treatment more affordable and to potentially lower your out-of-pocket costs.
For more information on bariatric surgery and the Affordable Care Act, see our obamacare weight loss surgery page.
if your insurance is through work: small groups (50 or fewer full-time employees)
Weight loss surgery insurance coverage guidelines for small groups (50 or fewer full-time employees) are the same as for individual/family plans. click here to jump to that section.
To confirm your small group bariatric surgery insurance coverage, you have three options:
If you have short-term disability insurance through your employer, please also see our section on disability insurance. you may be able to receive a portion of your monthly salary while you undergo and recover from surgery.
if your insurance is through work: large group (50+ full-time employees)
If you get your insurance through your job and your employer has 51 or more full-time employees, it’s entirely up to your company to decide whether or not to cover weight-loss surgery.
To confirm your coverage, you have three options:
If you find that bariatric surgery insurance isn’t included in your plan, you can visit our weight loss surgery insurance secrets page to learn how you can get your company to add coverage.
If you have short-term disability insurance through your employer, you may be able to receive a portion of your monthly salary while you undergo and recover from surgery. see our short-term disability section for more information.
if you are covered by medicare or medicaid
Medicare and Medicaid cover bariatric surgery as long as you meet their qualification requirements:
If you meet each of the above criteria, Medicare and Medicaid will cover the following procedures:
To get approved, you’ll need to be referred by your primary care physician or other treating physician (probably not just a self-referral to a bariatric surgeon). Your surgeon will also need to be listed in the Centers for Medicare and Medicaid Services (CMS) directory.
Medicaid coverage & bariatric surgeons
many surgeons don’t accept medicaid due to low reimbursement levels (they can’t cover their costs at the lowest rates medicaid can pay).
Contact your local surgeon to confirm if they will accept your Medicaid insurance. if they don’t, ask for a referral to a surgeon who does.
If you have the medicare advantage, you will need to verify that your chosen surgical team and hospital are in your insurance company’s network. contact your insurance company directly to find out (click here for a complete list of insurance companies and contact information).
See our medicaid/medicare bariatric surgery page for more information.
covered weight loss procedures
Most health plans that provide bariatric surgery insurance will pay for the following procedures (assuming you meet the coverage criteria):
Most insurance companies will not cover:
Click here to learn more about the different types of bariatric surgery.
how to get approved
If your plan includes bariatric surgery insurance, you will need to meet all coverage criteria from your insurance company (click here for list of insurance companies) to confirm the “medical necessity” of your surgery.
Assuming you follow all guidelines and provide complete and accurate information requested by your insurance company, the process from start to finish can take a month to a year.
To prove to your insurance company that your surgery is medically necessary, follow the typical steps:
