Gastric Bypass Surgery - Will Insurance Cover the Cost?

Depending on the type of major medical insurance policy you have, most insurance companies will pay for gastric bypass surgery (also called bariatric surgery) if you meet certain conditions. However, some insurance companies have exclusion clauses for treating obesity. These companies refuse to cover any treatment related to "losing weight." They will, however, treat the diseases caused by excessive body weight.

How do I qualify for coverage?

To qualify for coverage, gastric bypass surgery must be considered a medical necessity. The insurance company will make the final determination. They may rely on the information your doctor sends to them or they may require you to be seen by a doctor that they specify.

In either case, certain conditions must exist. Your weight problem must present a serious risk to your life. Don't be surprised if they require a complete psychological evaluation in addition to your medical records. It is no secret that people eat too much of the wrong kinds of food for many reasons. While genetics and metabolic rate do affect how much a person weighs, often the primary causes of obesity are emotional and psychological. Gastric bypass surgery will not fix these emotional and psychological problems. In fact, if these issues are not dealt with prior to or along with the surgery, the patient may be more likely to experience serious complications. For this reason, all insurance companies require both a medical and psychological clearance before they will approve the surgery.

Remember, insurance companies are businesses. If they think you are a good candidate to maintain the weight loss permanently and that the $25,000 to $50,000 dollar price tag for gastric bypass surgery now will save them money in the long run by eliminating payment for other weight related medical problems, they will most likely cover the surgery.

How much will my insurance carrier cover?

If you are approved for gastric bypass surgery, your insurance company will pay anywhere from 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 it is deemed necessary by the doctors and approved by the insurance company.

Several different expenses typically are associated with gastric bypass surgery, such as 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. Even if your insurance company will not cover 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?

Your surgical center should be able to help you determine what will and will not be covered by your specific policy. In addition, many surgical centers offer low-interest, long-term loans if you are not approved by the insurance company, do not have medical insurance, or have high co-payments.

Since 2000, the total cost of all medically necessary weight loss treatment 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 gastric bypass surgery or help you get back your co-payment for the surgery. Under the Internal Revenue code, treatment for weight loss includes behavioral counseling, nutritional counseling, prescriptions, and gastric bypass surgery if they are undertaken to treat or prevent specific diseases caused by excessive body weight.

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This article provides an overview of health issues related to gastric bypass surgery and is not intended to replace the advice of a medical practitioner. Please consult your doctor prior to making any major medical decisions.

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There are a total of 66 comments on this article.
Most recent comment threads on this article:

» left by Jennifer from Buford,Ga (3 years 208 days ago.)

I'm on medicaid insurance. Is it covered in Georgia?

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» left by Alana from Lawrenceville, GA (1 year 154 days ago.)

This procedure is not covered in Georgia.  I was on medicaid previously and attempted to get approved.  It is covered in many other states including Kentucky.  If you find out different please let me know, as I am interested in the procedure as well.

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» left by Anonymous (190 days 15 hours ago.)

Why should the taxpayers pay for your gbs?

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» left by Anonymous (168 days 7 hours ago.)

Exactly!!! Get a job and work out...

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» left by Anonymous (108 days 14 hours ago.)

You people are horrible. Some people have a condition that makes it extremely difficult if not impossible to loose weight, and in my fathers case, if he had not had the surgery he would have died. His weight was killing him, and he had been exercising and trying to loose weight for 20 years. These people also pay taxes and reserve the same right as the a**holes who don't have to worry about trivial things like I can't loose weight and might die but I don't make much money and can't afford insurance.

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» left by Chrissy from New Jersey (2 years 141 days ago.)

I have recently went through ALL of the requirements for the pre-op for the GBS, only to find out that my insurance company will not cover the procedure. I have put out over $1000 of my own money between co-pays and specialist not covered by my plan only to be turnned down in the end. I am a brital diabetic for 15 years now, on the insulin pump, and I also take 8 other pilss a day for my medical problems and I am onlyy 33 yrs. old. M theory is that in the long run it would save the insurance company money because of prescription cost, doctor visits, etc. all do to diabetic related problems. I am an Aetna member, in the state of New jersay, they say I need to prove it medically neccessary for the surgery, what else can i prove to them? I am an insulin dependent diabetic, with high cholestorol, with a BMI of 42% and I am only 33 years old. What can I do??? Anyone with anny suggestions please post something on here. I would greatly appreciate it.
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» left by Larry from Virginia (1 year 97 days ago.)

Get a lawyer to prove it is a medical requirement to treat MO.

 

Most insurance companies will NOT pay - if they did there would be a list some where that people could refer to.

 

Medicare in Virginia will pay 80%.  My insurance company will not pay (Optima) not matter want.  I too am looking for another insurance campnay that will help me.

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» left by Anonymous (177 days 3 hours ago.)

Aetna WILL cover the procedure. But your company has to purchase the rider that stipulates obesity surgery. I'm sure over your life time you'll definitely cost the company more in medical expenses than the surgery will cost. It's just your employer doesn't want the initial added cost of the monthly or yearly payments.
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» left by Anonymous (1 year 213 days ago.)

I live in Alabama and gastric bypass and lap band are covered by insurance companies . My husband had surgery one year ago and Medicare paid 100%. I have Blue Cross/ BS of Alabama and they have approved my procedure and it scheduled it for this August. If you really want to improve your life and health conditions , this is for you. There are going to be bad days, but over all it's safe and effective. The surgery has changed since it's early days and more doctors are being trained through the board that accrediates them as a Center of Excellence. Make sure that you find a Center of Excellance in your community, because they are highly trained for surgeries such as this one. Good Luck ! Rhonda H. Birmingham, Al

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» left by Anonymous (1 year 34 days ago.)

Rhonda, I'm so glad to find someone with a little good news.  I am looking for a doctor in the Montgomery area to do the lap band surgery.  I have BCBS Al.

What doctor did you use?

 

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» left by Anonymous (232 days 13 hours ago.)

i have bc/bs out of tennesseei live in ohio and they will not pay it!
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» left by Dave from Mobile,Al (1 year 141 days ago.)

I am looking into having gastric bypass done in Mobile,Al and my Medicare Complete covers it as long as it is life-threatening,which at 6'2" and 471 and most of the co-morbid conditions mine is definitely that.My doctor also mentioned when he interviewed me that BC/BS of Alabama covers it too.The wait and amount depending on your level of coverage.

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» left by Anonymous (232 days 13 hours ago.)

why won't bluecross/blueshield cover it in ohio?
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» left by Anonymous (1 year 37 days ago.)

Hey guys,

 

I was able to check if my insurance covered gastric bypass on obesitycoverage. I'm not sure how accurate it is but it was correct about bcbs covering mine.

 

Hope that helps.

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» left by Melissa from Ohio (252 days 11 hours ago.)

I do not think that Medicaid should cover the cost of this type of surgery. That is a program funded by other tax payers money. I would never ask other taxpayers to be responsible for such a surgery on my behalf.

 

I'm a single parent of two children. I had no help from the children's father with insurance and when it came to a certain point, medicaid turned us away for health coverage, then we had none. Now that is just crazy. Then I read posts here where folks want medicaid to cover their cost for this? Sorry, find another way. I don't mean to be rude but I'm a hard working single parent that they wouldn't help and I will not have my tax money used for this.

 

Find another way to get it covered please. Get into a health and fitness program, take better care of yourselves, eat helathier, do whatever you need to but don't expect others to handle this one. And let me tell you, I had thyroid cancer and the part of the bill that I didn't have covered by insurance is due and owing. Guess how they get the balance if I can't get it all paid? They take my state tax refund, which is fine, that's me paying my bill, not somebody else. I'm proud to pay my own bill somehow. 

 

It's time we all start taking responsibility for our own actions, health and well being.

It's things like this that has our economy so messed up. If this is where my tax money is going to go it's crazy! 

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» left by Anonymous (252 days 5 hours ago.)

I'm sorry, but I have worked and paid into Social Security & Medicare for years. I expect Medicare to pay for the operation now that I am at 65 years old and struggling to live another 20 years. I have never said anything about the illegal alien programs or the single parent programs that the government sponsorers. So, please don't try the bleeding heart therory, at least I have paid into my programs to the max every year.

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» left by Anonymous (228 days 2 hours ago.)

amen to that.. i worked two jobs all my life and paid in alot into the medicare program and now that i am relying it to come to bat for me i am going to take advantage of MY money being spent on me..medidaid the last time i checked is a government funded program that is why it varies from state to state. it does not say anywhere on your check stub that you paid any medicaid taxes for those on medicaid to use. so do your research before you give us a bleeding heart story. i worked hard long hours and paid for it by having a heart attack at the age of 49. the meds they have me on caused a huge increase in my weight...so i am having the surgery to correct all the problems the medications caused and for my heart as well.. it i go to bed with a clear consious every night.
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» left by Lisa from Florida (232 days 9 hours ago.)

Melissa, you must be skinny.

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» left by Anonymous (228 days 6 hours ago.)

Medicaid or Medi-cal does not denie anyone services if you complete all of the paper work they do on the other make working parents such as myself pay an out of pocket copay of $1500.00 per year before they cover any cost and I feel that most people who receive medical from the government are working they just cannot afford the monthly cost of insurance

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» left by Anonymous (30 days 6 hours ago.)

yeah you are a little high and mighty there sister. Where do you think your big tax refund comes from???earned income credit...That would be my tax dollars paying for you to breed. I think that everyone should be a little more understanding and a lot less judgmental when thinking about others' health issues. You have no idea why someone is overweight or why they are having difficulty losing or maintaining weight loss. Please try to be a little more open minded and sensitive.

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» left by Greg from High Point, NC (190 days 2 hours ago.)

Melissa ... wouldn't you want less tax dollars spent on Gastric BP than triple or more on all those other weight related health problems ... which can be endless. Your argument doesn't hold water. A logical argument could be ... you're against Medicaid in general. If your concern is with your tax dollars being poorly spent then you surely would support gastric bypass ... the more economical of the two.

 

Another argument could be ... it may be the right thing to do ... eleviating human suffering as obese people do suffer.

 

 

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» left by yzplnxg from Bham, Al (182 days 1 hour ago.)

Way.. too often obese people are blamed.. But you would never blame a cancer patient.. heart patient.. young baby born with a low birth rate in an ER with all types of problems...

 

And what makes you think anyone wants to pay for insurance for your children? Why should they be any more important than someone that needs WLS? Do they have more rights?

 

I'm 52.. worked all my life paying taxes, put myself through college and raised three children on my own. You haven't paid a dime for me.. and won't.. but I think you are very uneducated and inimformed regarding this subject or weight problems and WLS. Society as a whole is becoming obese and the government needs to find a way to proactively address this problem in the best cost effective way. Just saying "NO." Isn't working...

 

WLS is recommended by doctors in many cases and these people deserve a chance at life just as a cancer patient does or that small baby in ER.

 

 

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» left by Jamie from NC (152 days ago.)

Melissa - What a Crock! I hope that one of your loved ones never has to go through weight loss problems, maybe that would change your opinion...btw, I don't especially like paying for your kids runny nose either.... and one more thing, if you want obese people to take better care of themselves and lose weight on their own because their obesity problem isn't your problem, then you need to take a long look in the mirror. I didn't get you pregnant, and you have a choice whether or not to have kids (Birth control can be obtained free everyday of the week if you can't afford it) - you made the choice to have children, and my tax dollars took care of their medical needs. Sounds like a classic case of pot calling kettle black

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» left by Crystal from Siloam Springs, AR. (100 days 19 hours ago.)

I just want to know if any medicaid or Insurance in Arkansas covers this surgery? I saw a lot about Tennessee, Kentucky, and Ohio but not Arkansas, anyone?

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» left by Anonymous (95 days 12 hours ago.)

You probably need to speak with your insurance company in detail, but many of them will probably deny your claim unless you can prove to them that you've tried everything else (diet, exercise, etc.) and failed before they pay for surgery.

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» left by Grace R. from Hollis, NH (88 days 9 hours ago.)

I just need to add my two cents about all the hype on whether or not the government insurance should cover this type of surgery or not. Im usually not one to call out a person, but some people are not seeing beyond their nose on this issue. The morbidly obese, disabled americans, whom have paid into "our" tax system are entitled to use it. If they are ill, they need to get well. If they keep becoming ill, BECAUSE of being morbidly obese, dont you think its costing MORE???? Its less expensive in the long run to provide preventative maintenance, just as a Dr would perform a double or triple heart bypass. Try to think beyond. Your not the only one putting money into the tax system, and us americans are not the only ones to spend it either. Ease up!!

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» left by jaqueline from WA (85 days 11 hours ago.)

Does anyone know about any insurance in Washington state that covers this at all? or what companies might have said insurance? i've been without insurance almost my entire life so being able to prove this is a problem for me is difficult.

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» left by Wendy Schad from Pace Florida (85 days 9 hours ago.)

Does anyone know if Florida Medicaid pays for gastric bypass surgery?

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» left by Anonymous (33 days 4 hours ago.)

staywell does again as of march 9th 2009

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» left by Melissa from WI (61 days 8 hours ago.)

Wisconsin Medicaid does pay for these procedures you must be under a doctor suprvised diet for 3 months . I am going through the surgery soon. Gl to everyone. And to the people that think this should not be a covered issue... It costs more to care for people that are Obese with other health issues in the long run. And many people have payed taxes!!! Get over yourselves. Some people are obese because of hereditary genes. Some people were in accidents and are not as mobile as they used to be. Surgery has improved peoples chances on returning to work...

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