Thanks to precise technology and decades of research, modern bariatric surgery is safer and more effective than ever before. However, bariatric procedures are often very expensive too, especially with the current United States healthcare system.
American patients may pay up to $24,000 for a gastric bypass, while their Canadian counterparts face an average bill of $20,000 for the same procedure. Overcoming obesity will reduce healthcare costs significantly over time, but the upfront cost prevents many patients from experiencing these life-changing benefits at all.
Fortunately, you have options. As obesity rates continue to rise throughout the world, many insurance companies, employers, and governments have realized the value of effective obesity treatment options like weight loss surgery. Find out if your insurance covers weight loss surgery, what you must do to qualify, and how you could save money by traveling abroad for your procedure.
Does Your Insurance Cover Weight Loss Surgery?
Covering the costs of bariatric surgery is a smart way to fight a growing public health crisis, but not every provider has caught on just yet. Reach out to your insurance representative to learn the details of your specific policy, and research laws and options that may affect your coverage too.
State and Federal Laws
If you live in the United States and belong to an individual, family, or small group plan (between two and 50 employees), determining your coverage could be as easy as identifying the state you live in. The following 23 states consider bariatric surgery an “essential” health benefit, making coverage a federal requirement under the Affordable Care Act:
- Arizona
- California
- Delaware
- Hawaii
- Illinois
- Iowa
- Maine
- Maryland
- Massachusetts
- Michigan
- Nevada
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Carolina
- North Dakota
- Oklahoma
- Rhode Island
- South Dakota
- Vermont
- West Virginia
- Wyoming
Some of these states cover additional health benefits, such as nutritional counseling and weight loss programs, but only Michigan mandates coverage for all three options.
Employer Plans
If you have a large group insurance plan, federal health care requirements only apply to obesity screenings and counseling. Weight loss surgery and other essential health benefits are up to the discretion of your employer. However, employer plans aren’t set in stone.
If your insurance doesn’t cover bariatric surgery (or you’re not sure), it doesn’t hurt to ask. Obesity is an expensive condition, and bariatric surgery is an effective solution. Companies may prefer surgical intervention to decades of health care costs, absenteeism, disability payments, and other obesity-related expenses.
Do You Qualify for Weight Loss Surgery?
If your insurance does include coverage for bariatric surgery, you will need to meet some specific criteria in order to qualify. These rules vary from policy to policy, but they are designed to ensure that you’re a good candidate for the procedure. Insurance companies don’t want to pay for unnecessary or extremely high-risk procedures, and bariatric surgeons will not operate on patients who aren’t fully committed and medically vetted.
Factors to Consider
Your coverage will depend on your weight, health, and ability to comply with all medical and legal requirements. Some of the most common requirements for bariatric surgery coverage include:
- Body mass index (BMI) of at least 35 (if you have related health problems) or 40 (if you don’t)
- Medical clearance from your physician
- Medical recommendation from another doctor (not your bariatric surgeon)
- Surgical clearance from a mental health professional
- Evaluation with a registered dietitian
- Letter of medical necessity
- Participation in a weight management program
At Angeles Hospital, we consider many of these factors before we begin the admissions process. Whether or not you rely on insurance coverage, meeting the basic criteria and making proper preparations will minimize your risks and maximize your results.
What if You’re Not Covered?
As many as 88% of all bariatric surgeries in the United States are funded by Medicare, Medicaid, or a private insurance plan. However, that leaves 12% of patients to foot staggeringly high bills from American hospitals, and more than a third of all eligible patients cannot afford bariatric surgery at all. Additionally, many patients whose surgeries are technically covered still struggle to pay for the procedure and related expenses.
If you’re uninsured, under-insured, or your insurance doesn’t cover bariatric surgery, don’t think that weight loss surgery is not an option. There are a few actions you can take:
Talk to Your Employer or Provider
Obesity increases your risk of heart disease, diabetes, and many other chronic health conditions that require expensive treatment. Your employer or insurance provider may be receptive to changing their policy if they believe it will reduce their future expenses. Remind the decision-makers that obesity also causes absenteeism and decreased productivity.
Schedule Your Surgery Outside the States
Hospitals in many countries count on insurance providers to foot steep bills, so prices are 40-70% higher than they are in Mexico. If you can’t afford weight loss surgery in your own country, consider traveling abroad for your procedure. Angeles Hospital, for example, has a state-of-the-art facility and world-class weight loss surgeons that meet (and often exceed) the standards of far more expensive hospitals in the United States. Case managers will help take care of everything, from medical records to travel and hotel arrangements, as you prepare your mind and body for this life-changing transformation.
Take Control of Your Health
If you’re a good candidate for bariatric surgery, don’t let steep prices or insurance restrictions get in the way. There are plenty of healthcare providers like Angeles Hospital that work hard to make this life-changing treatment more accessible and affordable. As you consider if weight loss surgery is right for you, make sure to review your insurance policy carefully and consult your physician about your weight loss goals and options.
