Bariatric Surgery & Insurance – Are You Covered?

On average, adults who suffer from obesity pay 81% more for healthcare than those who do not. These expenses come in the form of prescription medication, medical bills, special equipment for your home, and other expenses. 

Most insurance companies across the U.S. have begun listening to the evidence that shows that surgery for obesity is more effective and more affordable long-term than treating the symptoms of obesity. Under the Affordable Care Act, some states require insurers to include bariatric benefits when selling plans on the marketplace and by 2016, nearly half of states mandated that bariatric surgery be covered by insurance. 

However, insurance firms still deny people coverage for bariatric operations. A denial could come because of the state where you get your insurance, your employer’s health plan, your inability to meet insurance requirements, or a combination of factors. This blog explores the cost of bariatric surgery, how to find out if this type of surgery is covered by your plan, and what options you have if it is not. 

The Cost Of Weight Loss Surgery

Weight loss surgery can cost anywhere from $17,000 to $26,000 nationally. The price of your weight loss surgery depends on a few factors. 

• The type of surgery you elect to have plays a role in the cost. Gastric bypass, adjustable gastric banding, sleeve gastrectomy, and duodenal switch surgery all carry different costs.
• Hospital prices, anesthesia fees, and other fees can all play a role. This is usually based on where the bariatric clinic or hospital is located, and the technical equipment and skill needed to perform the surgery you choose.
• The hospital or center you choose will also affect the price. Additionally, some locations include hospital stays and pre- and post-operation treatment in the listed cost and some do not. 

How Can You Find Out If Your Insurance Will Cover Weight Loss Surgery?

If you don’t know which bariatric center or hospital is in your insurance’s network, call your insurance to find out if and where weight loss surgery is covered.

Weight loss surgery coverage varies a great deal, as does the definition of ‘medically necessary,’ so be prepared to ask questions. A few good questions to ask are:

• Does my policy include bariatric benefits or does it exclude bariatric benefits?
• What does my insurance company deem ‘medically necessary?’ Are there any other criteria I need to meet?
• What percentage will the insurance cover? If it’s <100%, what will I be responsible for?
• Will I need to pay a deductible or copay, and how much will this be?

Do you already know where you are going to have your surgery? Gather your policy information and contact them to verify your insurance coverage for weight loss surgery. At the BMCC, our friendly front office staff is happy to verify your coverage for you when you make an appointment with us. 

What Requirements Do Some Insurance Plans Have?

The prerequisites needed for your insurance to cover your weight loss surgery will vary. Some of the most common requirements include:

• Age must be 18 or older
• A body mass index (BMI) of > 40 or a BMI of >35 (with an one of four common obesity-related health conditions such as high blood pressure or type 2 diabetes). 
• Proof of failure to lose weight or keep weight off through other weight loss methods over time.
• Participation in a medically supervised weight loss program mandated by the insurance firm
• A diagnosis  of morbid obesity
• A professional psychological and dietary evaluation

What If My Insurance Doesn’t Cover Bariatric Surgery?

Most bariatric clinics accept cash payment for people who don’t have insurance or have insurance that doesn’t cover bariatric surgery.  

At the Bariatric & Metabolic Center of Colorado, our cash-pay prices are some of the lowest not just in Colorado but also in the nation—often by thousands of dollars. Additionally, our fees do include extensive preoperative education, hospital stay, and anesthesia.

Bariatric Surgery at the Bariatric & Metabolic Center of Colorado

At the Bariatric and Metabolic Center of Colorado, we accept most major Colorado and national insurance providers. If you’re in the Health Colorado Exchange, your plan is required to include bariatric benefits. If you do not have insurance or your surgery is not covered, our prices are significantly below the national average and we offer transparent, all-inclusive cash pricing plans. 

To find out if you have insurance coverage at the Bariatric and Metabolic Center of Colorado, contact us today!