Gastric Sleeve surgery is often covered by most large insurance providers. However, getting approval can be quite difficult. Even if you meet the requirements, you may still be denied for various reasons. To be eligible for gastric sleeve insurance coverage, you will have to meet a variety of requirements and qualifications.
Gastric Sleeve Insurance Requirements
Every insurance provider approves coverage based on different prerequisites and criteria. Contact your provider to determine if they include bariatric surgery such as gastric sleeve and gastric bypass. For gastric sleeve surgery, most health insurance companies require the following:
- Body Mass Index of 40 or above
- A body mass index (BMI) over 35 with at least one obesity-related comorbidity (health problem), such as type 2 diabetes
- Must have documentation in your medical records confirming that previous attempts at medical treatment for obesity have been unsuccessful
Steps to Get Approved for Gastric Sleeve Surgery
To prove to your insurance carrier that your surgery is medically necessary, you typically need to follow the following steps:
- Have the minimum requirements for insurance coverage
- Follow a supervised weight loss program usually provided or accepted by your insurance company
- Set up a consultation with a bariatric surgeon who accepts your insurance
- Receive clearance from your primary physician. A letter is required for insurance approval
- Psychological evaluation with a letter of approval
- Nutritional evaluation with a letter of approval
- Send all evaluation documentation to your insurance provider. Include a detailed health history with proof of any past obesity-related comorbidities and failed attempts at weight loss programs
If approved, start the process of scheduling your bariatric surgery. If you are denied, try seeing your eligibility for gastric sleeve surgery in Mexico
How Long Does it Take for Insurance to Approve Gastric Sleeve?
Every insurance provider has different time periods to get back to you for approval. Generally, it takes between 2 weeks to 1 month to be approved. Sometimes, insurance providers will approve patients before finishing their required evaluations and documentation – even though it still needs to be done.
Ask your insurance provider about the approval process and the estimated duration. Insurance guidelines typically require up to a year for approval.
What To Do if You Are Denied Insurance Coverage
If you can’t afford or get insurance for bariatric surgery in the US or Canada, consider medical tourism. Medical Tourism connects you to certified facilities and surgeons from across the world, including Mexico.
In Mexico, gastric sleeve surgery is usually self-pay but at a fraction of the price in the other countries. You can find locations like Mexico Bariatric Center® with packages starting at $4,395 that offer payment plans and financing options. The requirements for gastric sleeve surgery include;
- 30+ Body Mass Index
- Age 18-65 (Sometimes younger and sometimes older)
- Surgeon Approval (Fill out a Health Questionnaire to see if you are accepted)
Additionally, there are great alternatives besides getting weight loss surgery in the United States. Mexico Bariatric Center has become an industry leader in weight loss surgery in Tijuana, Mexico. MBC specializes in Gastric Sleeve (vertical sleeve gastrectomy), gastric bypass surgery, gastric banding (LAP-BAND), and much more.