Many Americans are critically overweight and suffer from other medical conditions as a result of their obesity or morbid obesity status. In 2013, nearly 160,000 patients in the U.S. had bariatric surgery, which was about the same number as in 2004. According to the American Society for Metabolic and Bariatric Surgery (ASMBS), that is only about 1% of 18 million adults who qualify for the surgery.

Out-of-pocket bariatric surgery in the United States is quite a bit of money. That is why patients look into their insurance to cover this life-changing surgical intervention. Not all insurance policies have bariatric coverage, and the ones that do are challenging to qualify for.

Insurance Coverage for Weight Loss Surgery

Surgeons believe that the low surgery number is not only caused by economic difficulties but also the social stigma against undergoing weight loss surgery. However, many feel that insurance coverage is the biggest reason.

According to AP, two-thirds of all health plans sponsored by employers don’t cover the costs of weight loss surgery.

Different insurance plans:

  • Individual/Family or Small Group Policy
  • Large Group Policy (through an employer with 50+ employees)
  • Medicare
  • Medicaid

Insurance outfits with bariatric coverage,

  • Aetna
  • Blue Cross/Blue Shield (BCBS)
  • Humana
  • UnitedHealthcare
  • Cigna

Insurance companies that do cover bariatric surgery require special diets and psychological evaluation prior to having a procedure scheduled and included. Only 23 states require insurers to cover weight loss surgery. When this system is involved, most plans require that the patient pay up to 50% out of pocket, which can be tens of thousands of dollars alone.

How to Get Your Insurance Cover Weight Loss Surgery

Ultimately, insurers believe that bariatric surgery should only be administered to those as a last resort. However, new guidelines from the American Heart Association, Obesity Society, and the American College of Cardiology in November 2013 call for doctors to address obesity head-on and to calculate a patient’s body mass index (BMI) yearly.

“All major surgeries are risky. This one is life-altering, and if there is an approach that’s less invasive and less dangerous for the patient, you want to try that one first,” says, Susan Pisano, a spokeswoman for America’s Health Insurance Plans, an insurance industry trade group.

Roughly one-third of all American adults are obese – defined as a BMI of more than 30. Weight loss surgery is recommended for those with body mass index readings of over 40 and over 35 for those with risk factors for:

Typical requirement to get your insurance to pay for your procedure,

  • Unsuccessful weight loss with diet and exercise
  • BMI of 40 or higher, or
  • BMI of between 35 and 40 and weight-induced health problems, such as type 2 diabetes and high blood pressure

What States Require Insurance Companies to Cover WLS

According to the study, only 25% of employers covered weight loss surgery in states where obesity is the highest, such as Mississippi and Arkansas. Following federal guidelines for bariatric surgery, insurance companies only recommend the procedure to carefully select patients who have failed other methods of losing weight for a period of time.

States that bariatric coverage for all individuals, families, and small groups, insurance plans cover bariatric surgery is required by the Affordable Care Act (ACA),

  • Arizona
  • California
  • Colorado
  • Delaware
  • Hawaii
  • Illinois
  • Iowa
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Rhode Island
  • South Dakota
  • Vermont
  • West Virginia
  • Wyoming

Final Words

While some patients believe that weight loss surgery is a cost-effective way to treat obesity, others believe that educating kids and teens on healthy eating is more effective. Others talk about the safety of the procedure and believe that it can be a dangerous weight loss option.

In 1998, one in 100 died from the procedure, while today just 1 in 1,000 do.

Ultimately, for those who take medications to control conditions that are affected by weight issues, bariatric surgery is a must. Medical tourism in Mexico with MBC (Mexico Bariatric Center®) is an alternative for patients without coverage or insufficient coverage.

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