Does Insurance Cover Bariatric Surgery?
Financial ConsiderationsCovering the cost of bariatric surgery is a major consideration for many people. Fortunately, most commercial (private or employer-provided) insurance plans approve all four typical weight loss surgical procedures: gastric bypass, duodenal switch, vertical sleeve gastrectomy, or gastric banding procedures with LAP-BAND® or REALIZE® bands.
Approval requirements usually include a BMI over 40, or a BMI between 35 and 39 if the patient also has certain medical conditions such as diabetes, sleep apnea, or high blood pressure. (See bariatric surgery qualifications from the NIH, which insurance companies often reference.)
Some insurance companies have a mandatory three-month weight management protocol that patients must complete before surgery. Some have a protocol as long as six months.
For all plans, dietary and psychological evaluations are always mandatory. This is a practical step that helps ensure a patient’s readiness for the procedure.
Medicare and Medi-calMedicare covers some bariatric surgical procedures if the patient meets certain conditions related to morbid obesity. Recently, Medicare expanded its coverage to include vertical sleeve gastrectomy.
Medicare.gov - bariatric surgery coverage
Medi-Cal usually does not provide full payment for weight loss surgical procedures.