Gastric Sleeve Insurance Coverage: What Is Covered
Almost all PPO Insurance companies recognize the necessity of the Gastric Sleeve operation for patients who have been unable to find success using other non-surgical weight loss methods. They understand that as you lose more weight, the less likely it is that you will suffer from other obesity-related conditions, such as type 2 diabetes, hypertension and obstructive sleep apnea.
Gastric sleeve insurance coverage may also even include the post-operation elements that are necessary to be successful with your procedure such as support groups, exercise and nutrition counseling.
Whether or not your coverage is denied, our trained staff of insurance professionals are experts at helping you get your gastric sleeve surgery approved. Just call our Gastric Sleeve Insurance Hotline at or fill out our FREE Gastric Sleeve Insurance Verification Form!
Other Costs To Consider
When you choose to have gastric sleeve surgery you should also choose to change your lifestyle. Do not expect to keep the same habits that you had before surgery and successfully lose weight. The costs below will probably increase after surgery.
- Food costs may increase. Even though you will be eating less, you should be eating healthier and eating healthier usually costs more. Maximize every bite of food by choosing the healthiest options that give you the most energy.
- Will you get a gym membership?
- Nutritional supplements? Most surgeons recommend protein supplements after surgery. Quality protein supplements can cost $50/month or more.
- New clothes. As you start shrinking you will want to buy new clothes. Most people are amazed at how fast the weight comes off after surgery. New clothes are essential. Show off your new self!
- Cosmetic surgery? Some people choose to have cosmetic surgery to remove excess skin after surgery. This is something that can be considered down the road but you may want to start saving early if you feel this is something that you will want to have done.
How Does Tri State Bariatrics Help With Insurance
We have dedicated staff members to assist you. At your first formal office visit our Insurance Liaison will confirm that bariatric surgery is a covered benefit under your specific insurance plan.
She will also inform you at that time what tests or consultations are required by your insurance plan. These tests are commonly referred to as your pre-operative tests/consults.
Initially, this list of tests/consults may seem overwhelming, but we have dedicated staff members to help you navigate your way through this aspect of the process.
The Insurance Liaison will take care of submitting all the required information to your insurance company. This can only occur when:
- All tests/consults are on record in the office.
- Your surgeon has reviewed them with you and reviewed the risks & benefits of surgery.
- A surgery date has been set between you and the surgeon.
Your insurance company then reviews all the information submitted and makes a determination. This is commonly referred to as the approval process. The approval process varies among insurance companies. Once formal approval has been received you will be notified.
If for any reason you are denied, we will work closely with you on the appeals process.
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What Is Bariatric Surgery
Answer: Bariatric surgery is a surgery performed to help individuals with weight loss. These operations have an impact on patients weight and the health of their metabolism . In addition to their ability to treat obesity, these operations are very effective in treating diabetes, high blood pressure, sleep apnea, and high cholesterol, among many other diseases. These operations also have the ability to prevent future health problems. The benefits allow patients with obesity who choose to undergo treatment to enjoy a better quality of life and a longer lifespan.
Todays metabolic and bariatric operations have been refined over the course of many decades and are among the best-studied treatments in modern medicine. They are performed with small incisions using minimally invasive surgical techniques . These advancements allow patients to have a better overall experience with less pain, fewer complications, shorter hospital stays, and a faster recovery. These operations are extremely safe, with complication rates that are lower than common operations such as gallbladder removal, hysterectomy, and hip replacement.
Covered Weight Loss Procedures
- Gastric sleeve, gastric bypass, duodenal switch, & Lap-Band are covered under most plans that include bariatric surgery
- Other procedures are usually not covered by insurance but often have discounts, tax savings, & financing available
Most health plans that provide bariatric surgery insurance will pay for the following procedures :
Your surgeons office will be very experienced in managing the above process and may have all of the required personnel on staff .
to get started. Most offices will check your insurance for free to confirm coverage criteria.
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You Have Had Your Initial Consultation Now What
During your first appointment, your provider will outline specific requirements you need to meet in order to be eligible for surgery. This includes appointments with a health psychologist, supervised diet visits and additional appointments depending on any medical conditions. Within the week after your consultation, you will receive a phone call from our administrative staff to walk you through your bariatric surgery plan and help schedule your appointments.
Who Needs To Undergo Weight Loss Surgery
Anyone with a BMI of over 35 is recommended to undergo bariatric weight loss surgery.
This is an excellent and effective way to lose additional weight and minimize the risk of developing health complications, such as high blood pressure, type 2 diabetes, depression, breathing problems, and even cancer.
What Insurance Companies Cover Weight Loss Surgery
In simple words, if you weigh over around 200 lbs. then you should undergo weight loss surgery if the doctor advises you to.
Apart from this, if you have a family history of obesity, or tend to gain weight fast, then bariatric weight loss surgery is highly advised for you.
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How Long Does It Take Medicaid To Approve Weight
Medicaid also allows weight-loss surgeries if you meet criteria, but recent studies show approval make take longer.
Insurers usually take a month to approve weight-loss surgeries. However, wait times for Medicaid approval can take five months or more. During that time, Medicaid will review your records and input from your doctor before making the decision.
Cost Of Gastric Sleeve Surgery Without Insurance
Gastric sleeve surgery is a type of weight-loss surgery that involves removing a large portion of the stomach in order to reduce the amount of food that can be consumed. The cost of gastric sleeve surgery without insurance can be very expensive, as it typically ranges between $15,000 and $25,000. The cost of the procedure can vary depending on the location, the expertise of the surgeon, and other factors. It may also be necessary to pay for pre- and post-operative care, which can add to the overall cost of the procedure. Additionally, those without insurance may not be eligible for financing options, which can make the procedure even more expensive.
The average cost of bariatric surgery is $23,000, with the cost ranging from $14,000 to more than $30,000. We provide some of the lowest cash pay prices in Colorado for surgery, so even if you are not covered by insurance, you can still have the procedure. There is no other clinic in Denver that offers such low prices for the three types of bariatric surgery available at BMCC. Our self-pay fees are clearly itemized so that you can plan your total out-of-pocket expenses. The average cost of a gastric sleeve procedure is $14,500 in the United States. In this case, your insurance premium will be significantly reduced because you are not insured but are paying cash. Gastric bypass surgery is estimated to cost $23,000 in the United States.
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Lets Take A Closer Look At The Different Types Of Bariatric Surgery
Some of the common types of Medicare bariatric surgeries include gastric bypass, lap band surgery and gastric sleeve surgery.
Gastric bypass surgery
This common malabsorptive weight loss surgery is also known as Roux-en-Y gastric bypass . In this procedure, a small stomach pouch is created to restrict food intake. The rest of the stomach is bypassed via a Y-shaped segment of the small intestine, which reduces the amount of calories and nutrients the body absorbs.
This surgery is defined as Laparoscopic adjustable gastric banding . This common weight loss procedure involves the placement of a hollow band around the upper end of the stomach, creating a small pouch and a narrow passage into the larger remainder of the stomach. The band is inflated with saline solution, which can be increased or decreased over time to alter the size of the passage.
Gastric sleeve surgery
This weight loss surgery is also commonly known as vertical sleeve gastrectomy or sleeve gastrectomy . This procedure involves the removal of the greater curvature of the stomach and approximately 80% of the stomach volume. While pyloric sphincter and stomach functions are preserved, the remaining stomach resembles a slender curved tube.
Can Anyone Get Weight Loss Surgery
No, itâs not always possible for anyone to get weight loss surgery. This is because itâs not always the best course of action for everyone. It also depends on whether you receive treatment through the public system or privately.
To be eligible for treatment in the public system , you need to have a body mass index of at least 35, demonstrate that youâve failed using other approaches and youâll have to undergo a psychological evaluation. Youâll also have to find a public hospital that will do this sort of treatment, of which there are only a few in Australia.
Private health insurers will require you to have a face-to-face consultation with a physician to determine if the surgery is necessary and some insurers require you to have a BMI above a specific number. However, these requirements are less restrictive than Medicare and you will have more choice of hospitals.
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Does Medicare Cover Bariatric Surgery
Medicare covers some weight-loss surgeries, including laparoscopic banding surgery and gastic bypass surgery.
You need to meet requirements and deemed severely obese. You and your doctor need to get pre-approval for weight-loss surgery.
Similar to other insurers, Medicare will likely require a BMI of at least 35, your weight must also be causing serious health issues and youve attempted for years to lose weight through diet and exercise.
Is Weight Loss Covered By Insurance
Health insurance covers some weight loss treatments, but often doesnt cover weight loss drugs and may have coverage restrictions. Coverage for weight loss depends on the plan.
Losing weight is a serious health matter for a lot of people, but health insurance doesnt always cover the cost of treatment. Treatments like weight loss drugs and surgery are sometimes covered by health insurance if the patient meets the requirements, and some weight loss programs may be covered by insurance as well.
Weight loss insurance coverage depends on your plan and your particular situation. Read on to find out about how treatments for weight loss are covered by insurance.
- The Affordable Care Act doesnt require health plans to cover obesity-related medications or surgeries, but screenings are covered.
- Health insurance plans may cover weight loss drugs, programs, or even surgery, but it depends on the specific plan.
- Obesity can lead to health problems and medical conditions, including Type 2 diabetes and high blood pressure.
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If Your Insurance Is Through Work: Small Groups
Weight loss surgery insurance coverage guidelines for Small Group are the same as for Individual/Family Plans. .
To confirm your Small Group bariatric surgery insurance coverage, you have a three options:
- Option 1 : Your local surgeon will contact your insurance company to determine your coverage details for no charge . Their office has been through the approval process with your insurance company many times, so let them work on your behalf to make the process go as smoothly as possible. .
- Option 2: Ask your Human Resources Department whether or not weight loss surgery is an included benefit under your plan.
- Option 3: Contact your insurance company yourself and/or check your Summary Plan Description . for the full list of United States insurance companies, contact information and bariatric surgery coverage criteria.
If you have short term disability insurance through your employer, also see our section on Disability Insurance. You may be able to receive portion of your monthly salary while youre having and recovering from surgery.
Will Health Insurance Pay
If you have health insurance, read your policy carefully, and work closely with your insurer and your doctor to see what’s covered. Under the Affordable Care Act, some states require that health insurers selling plans in the Marketplace or directly to individuals or small groups cover bariatric surgery by 2016 nearly half of states mandated coverage for these plans.
Most insurance companies recognize that people who are overweight and obese are more likely to get serious health conditions such as type 2 diabetes, high blood pressure, heart disease, high cholesterol, and sleep apnea.
If you donât have health insurance, have insurance through a large employer , or you live in a state that does not include bariatric surgery in its essential health benefits, youâll likely have to pay the entire bill yourself. Some weight loss surgery centers can help you get a loan that you can repay over a number of years.
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Gastric Sleeve Cost By State
The cost of gastric sleeve surgery can vary greatly depending on the state in which you live. Generally speaking, gastric sleeve surgery is most expensive in states with higher cost of living, such as California and New York. On the other end of the spectrum, states such as Oklahoma and Mississippi tend to have lower gastric sleeve costs. Depending on your state of residence, the total cost of gastric sleeve surgery can range anywhere from $5,000 to $20,000. Because of the wide range of costs, it is important to research the cost of gastric sleeve surgery in your state before making a decision.
I may have stomach discomfort during the gastric sleeve procedure. Following gastric bypass surgery, you should take steps to avoid further stomach stretching. How much weight can you lose from having gastric bypass surgery? It is expected that weight loss will be moderate after gastric sleeve surgery. After bariatric surgery, the Duodenal Switch Vitamin Guidelines were published. Lap band erosion Jacquis Story, as told through her mother. There is a lot of information on lap band fills.
Complications can occur when the lap band is bent. A mini-gastric bypass is a wise and wise use of resources, both good and bad. The factors that must be considered when selecting health insurance coverage for weight loss surgery. Using the calculator below, you can estimate how much weight you will lose following surgery. A state-by-state breakdown of gastric sleeve surgery costs.
Cash Paying For Surgery
If your insurance does not provide coverage for bariatric surgery, there are other options available to you. Depending on plan language, consultations, nutritional counseling and pre- and post-operative tests, labs and follow-up visits may be covered, although surgery is not. Verification of your benefits will help us outline potential costs to you at your consultation.
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So How Does Bariatric Surgery Insurance Work
Few years back, bariatric surgery was a standard exclusion across the industry. However, with the changing needs of the world and the technical advancements, bariatric surgery is considered by many insurance companies now. If you are hospitalized for a Bariatric Surgery which is medically necessary, on the advice of a Medical Practitioner, we cover the related medical expenses. However, it is to be kept in mind that Bariatric Surgery Insurance benefit can be availed only when it is medically necessary and not for cosmetic purposes.
Do You Meet The Weight Loss Surgery Requirements Talk With Your Health Insurance Representative
This is one of the most important questions you can ask concerning whether or not your insurance will cover weight loss surgery. In order for it to be covered, health insurance companies frequently require that an extensive set of criteria must be met.
Does insurance cover weight loss surgery? It depends upon whether or not you meet the qualifications.
Health care plans also change from time to time, and what may have been covered last year, wont be included in the current year. The same goes for doctorssome may change as to whether they are in or out of network.
If you have a question about pre-authorization, we urge you to also speak to us. We can help you navigate the often-confusing world of health care insurance.
One important note: While this quiz is an excellent guideline, its no substitute for actually speaking with your health care insurance representative. They will have the latest information you need in order to make your decision.
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Weight Loss Surgery Is A Big Step That Can Come With A Big Price Tag Does Insurance Help Pay For Gastric Sleeve Surgery Heres What You Need To Know
Story by: Sara Thompson on October 10, 2022
The average cost of weight loss surgery in the United States ranges between $17,000 and $26,000 , according to the American Society for Metabolic and Bariatric Surgery. Whether insurance covers some of this cost depends on the insurance provider and the plan.