Most commercial (private or employer-provided) insurance plans approve all four typical weight loss surgical procedures — gastric bypass, vertical sleeve gastrectomy, gastric banding with LAP-BAND® or REALIZE® bands, or duodenal switch procedures — for the appropriate patients.
To receive approval, a patient usually needs to have a BMI (body mass index) above 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. Some insurance companies have a mandatory three-month weight management protocol that you must complete before surgery. Some have a protocol as long as six months.
For all plans, dietary and psychological evaluations are mandatory. This is a practical step that helps ensure your readiness for the procedure.
Your medical team can work with you to help you meet the particular requirements of your health plan in order to qualify for insurance coverage.
Medicare and Medi-Cal
Medicare covers some bariatric surgical procedures if you meet certain conditions related to morbid obesity. Recently, Medicare expanded its coverage to include vertical sleeve gastrectomy. Medi-Cal only covers the cost of surgery in certain California counties.
If you have Medicare, Medi-Cal, or Medicaid coverage, please be sure to find out what specific coverage is available to you by contacting your health plan.
Cosmetic Surgery After Bariatric Surgery
Many patients decide to have cosmetic surgery after bariatric surgery to remove excess skin. In general, insurance companies do not cover cosmetic surgeries, unless they are needed to resolve a medical issue, such as problems with your skin folds. It is important to explore these questions with your physician and your health plan.
