Understanding Bariatric Surgery Insurance Coverage on the Marketplace

Marketplace insurance plans vary in their coverage of bariatric surgery, but some do offer it.

In 2014, the Affordable Care Act required all marketplace plans to cover essential health benefits, which include surgery for obesity.

However, coverage may depend on the plan's metal level, with more expensive plans offering broader coverage.

Some marketplace plans may require a pre-approval or prior authorization before covering bariatric surgery.

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Bariatric surgery coverage varies depending on your insurance provider and the state you live in.

If you're covered by a private insurance company, you'll likely need a letter of medical necessity from your primary care doctor or weight loss surgeon to get approval for the surgery. This letter should include your height, weight history, and BMI, as well as a detailed description of your obesity-related health conditions and how they affect your daily activities.

Medicare typically requires candidates to participate in a six-month medically supervised weight loss program before they'll cover the cost of the surgery. This program must be led by a bariatric surgeon or primary care physician, and you'll need to provide detailed medical records and documentation of your weight loss efforts.

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Some private insurers may require a similar six-month diet and exercise program before approving the surgery. They may also ask for documentation of your participation in a physician-supervised diet plan, including office notes from the supervising doctor for at least six months.

Insurance companies often have specific requirements for coverage, so it's essential to check with your provider to see what's needed. You can also contact the surgeon's office for guidance on the authorization process.

Here are some common insurance requirements for bariatric surgery:

Keep in mind that insurance companies frequently change their coverage criteria, so it's crucial to confirm the requirements with your provider before proceeding with the surgery.

Insurance companies like Aetna, Blue Cross/Blue Shield, and United Healthcare typically cover bariatric surgery in Washington State.

If you're considering weight loss surgery, it's essential to contact your insurance plan to find out if the procedure is covered and what caveats may exist. Many insurance companies now offer coverage, including gastric bypass insurance.

Some insurance companies may foot the entire bill, while others will pay 80 percent of what is considered the "customary and usual" for the surgery. This percentage is determined by the insurance company.

Here are some insurance companies that cover weight loss surgery in Washington State:

Insurance coverage for weight loss surgery varies by state and insurance provider. If you're considering this procedure, start by contacting your insurance plan to find out if it's covered and what caveats may exist.

Many insurance companies now offer coverage for weight loss surgery, including private and public insurers. Some may even foot the entire bill, but others will pay 80 percent of the customary and usual cost for the surgery.

To get insurance coverage, your primary care doctor must inform the insurer that the surgery is medically necessary. They'll need to provide good medical and other documentation to back this up.

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Here are some insurance companies that typically cover weight loss surgery in Washington State:

To get approved for weight loss surgery, your doctor will need to provide a letter of medical necessity that includes your height, weight history, and BMI, as well as a detailed description of your obesity-related health conditions and how they affect your daily activities.

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The Affordable Care Act has its own set of rules regarding weight loss surgery coverage. Unfortunately, insurance companies are not required to cover bariatric surgery in all states, including Florida.

In states where bariatric surgery is considered an Essential Health Benefit, insurance companies must provide coverage for individual, family, and Small Group plans with 50 or fewer full-time employees.

To qualify for coverage, you'll need to meet the necessary medical criteria, which will be reviewed by our Insurance Specialist.

Medicare does cover bariatric surgery, but only if you meet the required medical criteria and documentation.

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Most insurance companies now cover bariatric surgery, which can lead to long-term weight loss and reduce the risk for heart disease, diabetes, and other health problems.

To find out if your insurance will pay for bariatric-related care, simply call them and ask. The fact that your physician feels surgery is medically necessary does not guarantee insurance coverage.

Every insurance company is different, and may require different information to qualify for surgery.

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Many insurance companies now cover bariatric surgery, which can lead to long-term weight loss and reduce the risk for heart disease, diabetes, and other health problems. It's essential to contact your insurance plan to find out if the procedure is covered and what caveats may exist.

Some states have different insurance coverage for weight loss surgery, so it's crucial to check with your insurance provider. Many public and private insurance companies now offer coverage, including gastric bypass insurance.

Insurance companies that cover weight loss surgery vary, but many pay 80 percent of what is considered the "customary and usual" for the surgery, as determined by the insurance company.

Here are some insurance companies that typically cover bariatric surgery in Washington State:

If your insurance plan doesn't cover weight loss surgery, you have the option to self-pay for the bariatric surgery services.

Many private insurance companies will cover weight loss surgery if your primary care doctor informs them that the surgery is medically necessary.

They will require a letter of medical necessity from your weight loss surgeon and your primary care physician. This letter should include your height, weight history, and BMI, as well as a detailed description of your obesity-related health conditions.

Your current medications and a detailed description of how the obesity affects your daily activities should also be included. A detailed history of past dieting efforts and a history of exercise programs, along with gym membership documentation, may also be required.

Some insurers now require detailed documentation of participation in a physician-supervised diet plan, including at least six months' worth of office notes from the supervising doctor. This can be a lengthy and detailed process, but it's essential to ensure that your insurance company covers the costs of weight loss surgery.

Here are the specific requirements that many insurance companies now have:

Insurance coverage for weight loss surgery varies by state and insurance provider, and some insurers may foot the entire bill, while others may pay 80 percent of the "customary and usual" cost of the surgery.

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To undergo bariatric surgery, you'll need to meet specific requirements set by your insurance company. Most insurance companies require you to have a supervised diet for 6 months or two 3-month periods within the past 2 years, followed by an evaluation by a dietitian and psychologist.

You'll also need to meet the standard NIH weight criteria, which varies slightly depending on your insurance provider. For example, some plans require a 5-year weight history, while others require a 3-6 month supervised diet.

Eligibility for bariatric surgery also depends on your medical history and current health conditions. If you have certain co-morbidities, such as hypertension, type II diabetes, or obstructive sleep apnea, you may be eligible for coverage.

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Medicare requires a six-month medically supervised weight loss program before covering the cost of weight loss surgery. This program is typically conducted through a bariatric surgeon or primary care physician.

To qualify for Medicare coverage, you must have a body mass index (BMI) of 35 or higher, along with at least one health problem related to obesity, such as heart disease or diabetes. You can calculate your BMI to see if you meet this requirement.

Medicare mandates that weight loss surgery take place at a specifically certified location. This ensures that patients receive care from a reputable and qualified provider.

Some private insurers require a letter of medical necessity from a doctor before agreeing to pay for weight loss surgery, but Medicare does not have this requirement. A surgeon will submit the claim to Medicare after performing the surgery on a candidate who has met all the Medicare requirements.

Here are the three types of weight loss surgeries that Medicare will cover, as announced by the U.S. government health plan for people 65 or older:

To ensure coverage, collect letters and documentation from all health care professionals who have treated you for health conditions related to obesity. This will help support your claim and ensure that you meet Medicare's requirements.

AETNA requires a 5-year documentation of a history by a doctor, supervised 6-month (or two 3-month periods) diet within 2 past years, evaluation by dietitian & psychologist.

Blue Cross/Blue Shield and Blue Cross Federal require supervised 6-month (or two 3-month periods) diet within 2 past years, evaluation by dietitian & psychologist.

CIGNA requires a supervised 6-month diet within 2 past years, evaluation by dietitian & psychologist.

United/MAMSI/MDIPA/Optimum Choice requires a 5-year weight history, evaluation by dietitian & psychologist, with some plans requiring a 6-month supervised diet.

Medicare/Medicaid requires a supervised 6-month diet, evaluation by dietitian and psychologist, participation in preparation/conditioning program with surgeon for 3 months, and eligible co-morbidities include hypertension, type II diabetes, obstructive sleep apnea, severe arthritis requiring joint replacement, or fatty liver.

Here are the specific requirements for each insurance company: