Insurance Information
How do I qualify for coverage?To qualify for coverage, bariatric surgery must be considered a medical necessity. Every insurance company has their own requirements and will make their final decision based on if a candidate meets those requirements. Many insurance companies rely on the information your doctor sends to them, but others may require you to be seen by their own doctor before they make a decision. To qualify for coverage, certain conditions must exist and your weight problem must put your life at serious risk. In addition to meeting their physical and medical requirements, many insurance companies require candidates to undergo a complete psychological evaluation. While genetics and metabolic rate do affect how much a person weighs, the primary causes of obesity are often emotional and psychological. Surgery will not fix these emotional and psychological problems. How much will my insurance carrier cover?There are a variety of different expenses typically associated with gastric bypass surgery: testing to determine eligibility for gastric bypass surgery, pre-admission testing, in-hospital costs, surgeon and other doctor fees, and post-surgery medication and care. If you are approved for bariatric surgery, your insurance company will pay between 50 to 100 percent of the hospital and doctor fees. Some policies will even cover in-home nursing care after release from the hospital if the doctor determines it is necessary. Even if your insurance company will not cover the cost of the actual procedure, they may cover one or more of the other costs related to your gastric bypass surgery. How can I make up the difference?Once we meet with you, our Surgical Coordinator will help you determine what will and will not be covered by your specific policy. Since 2000, the total cost of all medically necessary weight loss treatments has been considered a deductible medical expense for income tax purposes. Those tax deductions can help you pay for at least part of the cost of your bariatric surgery or help you get reimbursed for your surgery co-payment. Under the Internal Revenue tax code, treatment for weight loss includes behavioral counseling, nutritional counseling, prescriptions, and gastric bypass surgery if those treatments are prescribed to treat or prevent specific diseases caused by excessive body weight. |
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Depending on the type of major medical insurance policy you have, most insurance companies will pay for bariatric surgery if you meet certain conditions. However, some insurance companies refuse to cover any treatment related to "losing weight," although they will treat the diseases caused by excessive body weight.