Gastric Sleeve Surgery is generally covered by most large insurance providers. The process for approval can be quite difficult, as there are a variety of requirements and qualifications needed to be eligible for gastric sleeve insurance coverage.
Gastric Sleeve Insurance Requirements
Every insurance provider will have different requirements and criteria to be approved for insurance coverage. Most insurance providers have similar requirements, although it is best to check your individual coverage by contacting your insurance provider. For gastric sleeve surgery most insurance companies require the following:
- Body Mass Index of 40 or above
- A body mass index (BMI) over 35 with 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
Steps to Get Approved for Gastric Sleeve Surgery
To prove to your insurance company that your surgery is medically necessary, the following are the typical 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 that accepts your insurance
- Receive clearance from your primary physician – letter 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 along with detailed health history with proof of any past obesity-related comorbidities and failed attempts at weight loss programs
- Wait to get approved or denied by your insurance provider. 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 the process to be approved, and the length of time it will take. Most insurance requirements have guidelines in place to make approval take up to one year for gastric sleeve surgery to be covered.
What To Do if You Are Denied Insurance Coverage
In Mexico, gastric sleeve surgery is usually self-pay while also offering payment plans if needed. The requirements for gastric sleeve surgery include;
- 30+ Body Mass Index
- Age 18-65 (Sometimes younger and sometimes older)
- Approval by the surgeon (Fill out 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 of weight loss surgery in Tijuana, Mexico – specializing in Gastric Sleeve Surgery. The cost of VSG starts at $4,795 and ranges depending on which certified surgeon you choose and your medical history.
In order to see if you Pre-Qualify, click here.