Understanding Bariatric Surgery Coverage
  • What is Bariatric Surgery
  • Does your policy cover it?
  • How to determine?
Understanding Bariatric Surgery Coverage
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Is Bariatric Surgery Covered by Health Insurance?

If you are thinking that bariatric surgery is a solution to your weight loss management struggles, then the most important question will be whether the procedure is covered by youth health insurance or not. Bariatric surgery is an important step towards a better lifestyle and health, but you have to be aware of the financial aspect as well. Though some companies provide coverage for Bariatric surgery while some do not. This article will delve into the topic of bariatric surgery covered by insurance, helping you navigate the complex world of health insurance and its relation to the weight loss procedure.

What is Bariatric Surgery?

Bariatric surgery or weight loss surgery is a medical procedure designed to help people struggling with obesity. The surgery involves some techniques, such as gastric bypass, gastric sleeve, and gastric banding. It modifies the size of the stomach and its connection to the small intestine. The main aim of these procedures is to limit the amount of food intake, induce a sense of fullness with smaller portions, and alter the hormonal responses to food.

Why do you need a Biatric Surgery Cover?

The cost of bariatric surgery can be hefty. Health insurance for bariatric surgery can reduce the financial burden and encourage you to make decisions that will improve your overall health and well-being.

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Types of Health Insurance Plans

There are several health insurance plans that cover bariatric surgery, though they can differ accordingly. But these three main types are plans are easier to understand:

  • Health Maintenance Organization (HMO) The HMO plans require a referral from the primary care physician and limit coverage to the in-network providers.
  • Preferred Provider Organization (PPO) You will get more flexibility in choosing healthcare providers, both in and out of network in PPO plans. But it may involve higher out-of-pocket costs.
  • Exclusive Provider Organization (EPO) EPO is the hybrid of HMO and PPO plans, which provides coverage within a network of healthcare providers, excluding emergency cases.

What is the Criteria for Bariatric Surgery Covered by Insurance

There are several criteria that insurance companies have that patients must meet to be eligible for bariatric surgery coverage. These criteria include:

  • Body Mass Index (BMI) Patients with a BMI above 40 or 35 with obesity-related health conditions may qualify.
  • Documentation of Weight Loss Efforts The insurance companies require some details and documents of your previous attempts to lose weight through medically supervised programs.
  • Medical Necessity The doctor’s assessment of the health condition and potential benefits of the surgery are also a few important criteria to get covered.

How to Determine the Coverage?

  • Review your Policy Read your health insurance policy carefully and understand all the things that are being covered in it.
  • Contact your Insurance Provider Talk to your expert guide to know more about the Bariatric surgery coverage and the requirements.
  • Consult a Bariatric Surgeon Discuss the options and your potential eligibility for the weight loss journey with your surgeon.
  • Gather Documentation Collect all the necessary records and medical histories including weight loss documents and referrals.
  • Submit your Preauthorization Request Contact the doctor and their office to submit a preauthorization request to your insurance company.

Be Prepared with the Documentation

There are a few steps that need to be followed to get approval for insurance for bariatric surgery, such as medical assessment, document submission, and attending sessions. Be prepared to navigate through these documentation processes to increase the chances of approval.

Researching Bariatric Surgery Costs

The cost of bariatric surgery can differ based on several factors the type of procedure, experience of the surgeon, and the location of the center. You should go for this research and compare the costs of different providers for an informed decision.

How much time will it take to get the approval?

The approval process for bariatric surgery can vary as per the company. Some insurance providers take a few weeks while others take only a few days.

Documenting Weight Loss Efforts

Most of the time companies require evidence of your previous attempts at weight loss through supervised programs. Keep track of these programs in which you have participated for your reference. Following is the list:

  • Medical reports include a history of obesity-induced problems.
  • Any evidence of undergoing dietary and lifestyle changes for weight loss.
  • Proofs of any unsuccessful attempts at weight loss while undergoing pharmacological therapy.

What are the Exclusions?

Some of the usual exclusions for Bariatric Surgeries under health insurance are:

  • You cannot raise the claim during the initial waiting period of the plan.
  • In pre-existing conditions, Bariatric surgery does not get covered.
  • If you are going through this surgery due to any cosmetic or aesthetic reason, then it will not be covered.
  • If the weight gain is a byproduct of medication or poor mental health, the surgery for the same may not be covered.

Conclusion

To sum up, we need to understand that bariatric surgery can be life-changing for anyone, but at the same time, it can be costly too, and navigating bariatric surgery coverage can be complex. But understanding your policy and meeting the criteria are some of the important ways by which you can make informed choices related to your bariatric surgery and weight loss journey.

Understanding Bariatric Surgery Coverage: FAQs

1. Is bariatric surgery covered by health insurance?

Nowadays, health insurance covers bariatric surgeries too with specific terms and conditions.

2. What is the average cost of bariatric surgery in India?

The cost of bariatric surgery in India ranges from Rs. 2 lakhs to Rs. 6 lakhs. Moreover, the cost of the surgery depends on several factors

3. What is included in bariatric surgery?

The procedure of bariatric surgery includes gastric bypass, sleeve gastrectomy, gastric band, and duodenal switch.

4. What is the minimum weight for bariatric surgery?

The average weight of a patient should be 100 pounds and have a BMI of 40 to be eligible for bariatric surgery.

5. Can a normal-weight person get a gastric bypass?

Having a 35 BMI index or higher, obesity-related conditions, heart disease, or severe sleep apnea can go with gastric bypass.

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Sahil Singh Kathait

Written By: Sahil Singh Kathait

Sahil is a passionate content writer with over two years of expertise in the insurance domain. He uses his knowledge in the field to create engaging content that the customer can relate to and understand. His passion lies in simplifying insurance terminology, ensuring a hassle-free understanding for potential policyholders. With his outstanding collaborative efforts with people, he understands different perspectives and keeps readers' viewpoints at the forefront of his content writing approach.