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Does My Insurance Cover Bariatric Surgery?

According to The American Society for Metabolic & Bariatric Surgery (ASMBS), the average cost of bariatric surgery is $17,000 to $26,000. As such, many patients in Virginia want to know: Does my insurance cover bariatric surgery?

Continue reading to find out the answer to this question, including common requirements for coverage.

What Is Bariatric Surgery?

Bariatric surgery is a weight loss procedure that makes adjustments to the digestive system in order to treat obesity.

It is often recommended for women and men with class 2 obesity (BMI 35-40) and class 3 obesity (BMI 40 and above) who have been unable to lose weight or maintain weight loss with lifestyle modifications, such as diet and exercise, and medications.

Your doctor may also suggest bariatric surgery if you suffer from severe health issues, including type 2 diabetes and sleep apnea, that are directly related to obesity.

Does My Insurance Cover Bariatric Surgery?

In many cases, insurance will cover bariatric surgery to treat severe obesity and obesity-related comorbidities, such as heart disease or diabetes.

However, most insurance companies require patients to obtain pre-authorization and submit requested documentation in order to review your request and approve surgery.

What Are the Requirements for Coverage?

If you are interested in bariatric surgery and want to know – Does my insurance cover bariatric surgery? - it’s important to contact your carrier directly and ask if bariatric surgery is a covered benefit or if it’s specifically excluded from your policy.

Next, find out if you need pre-authorization, including requirements for coverage and necessary documentation.

While requirements will vary according to the company and policy, most insurers require the following:

· BMI of more than 40 or a BMI of 35-39.9 with at least one obesity-related comorbidity

· Documentation of participation in a physician-supervised weight loss program

· Complete medical evaluation, which may include:

· An assessment by a surgeon qualified to perform bariatric surgery and written recommendation for surgery

· Medical evaluation recommending bariatric surgery

· Clearance for surgery by a mental health provider

· Nutritional evaluation by a physician or registered dietician

Learn More

If you are considering weight loss surgery, please call our office today to schedule a comprehensive consultation with one of our highly skilled and talented bariatric surgeons.

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