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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Comments on this article:

» left by Jennifer from Buford,Ga (2 years 361 days ago.)

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

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» left by Alana from Lawrenceville, GA (307 days 22 hours 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 Barbara from Kentucky (261 days 23 hours ago.)

Can you tell me, please, what insurance company in KY covers this procedure?

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» left by Chrissy from New Jersey (1 year 294 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 (251 days 1 hour 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 (1 year 1 day 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 (187 days 23 hours 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 (20 days 22 hours ago.)

i have bc/bs out of tennesseei live in ohio and they will not pay it!
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» left by A little privacy is nice from United States (312 days 3 hours ago.)

United Health Care - Choice Plus covers this. However, it isn't just about the insurance company. It is also about the employer. The employer who chooses the plan also may pay some of the cost. UHC - Choice Plus based upon our insurance will cover 100% for the whole procedure, on in-network. They will also pay 100% for specialists (including Nutritionist) and surgeons. On the Psychologist for the Psych Eval one must pay only the $15 co-pay per visit. For any regular physician appointments it is just the $15 co-pay per visit. For any prescriptions it is your standard prescription rate. The requirements under this plan are that it has to be a medical necessity.

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» left by Alana from Lawrenceville, GA (307 days 22 hours ago.)

I want to reach out to everyone that has left a comment here. I am trying to get enough people to assist me in pressing our government to pressure insurance companies to revise their treatment of obesity. I would like to see gastric bypass and lap band surgeries to be considered preventive methods.

 

Preventive because once the surgery is completed most health issues such as hypertension, heart disease, high blood pressure, heart attacks all decrease as a result of the weight loss. The long term benefits would be less expense to the health insurance companies because obese persons would not need the prior medication, they would not need to be hospitalized due to weight related illness, they would be healthier therefore they would not have to visit the doctor as often. If more health insurance companies would support weight loss surgeries, the percentages of death caused by obesity would decrease. We all know that being heavy contributed to higher risks of death at early ages as well as health problems that become persistent and lifelong. With the pressure of so many people and support of our government and state officials, we can get this goal accomplished.

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» left by Dave from Mobile,Al (294 days 13 hours 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 (20 days 22 hours ago.)

why won't bluecross/blueshield cover it in ohio?
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» left by Anonymous (267 days 10 hours ago.)

Everyone needs to understand that you can fight any insurance company you just have to hang in there and keep appealing, finding a good Bariatric Surgeon to help you with the filing processes and appeals is best but you can do it on your own. Whenever a procedure is submitted for approval unless it is a common procedure or a life threatening condition the first response from the Insurance Carrier is almost always a denial and a large percentage is denied after the 1st appeal but go back after them again. My husband and I had to fight for 13 months, in that time we had to appeal the decision 2 times along with keeping up with monthly visits to the Dr to track his weight and other conditions. We also made sure my husband saw specialists for every condition he had almost monthly. My husband had many medical conditions that made the surgery a medical necessity and over those 13 months the insurance company could see the cost of his conditions. My last conversation with the insurance company consisted of this comment - you will pay for chemotherapy to give a terminally ill cancer patient 6 more months of life but you won't pay for bariatric surgery to give someone the chance at years of extended life. I'm not saying you shouldn't pay for Chemotherapy but I am saying Obesity is a disease and why shouldn't my husband have a chance at life too. Insurance companies know that most Obese people have been told so often that if they weren't obese they wouldn't have so many medical problems. They are sent home with a prescription to lose weight and it will go away, so not wanting to hear this so often obese people just quit going to the Dr unless the illness or condition becomes to much to handle. My husband was approvied in Feb 08 and now 8 months later he has lost 126 lbs and ALL of his medical conditions have vanished. The fight is worth it no matter how long it takes. And those of you who can afford it if you are denied over and over again, especially if you have a lot of co-morbid conditions - Sue the insurance company for causing you undue harm and indangering your life and make sure there is BIG media coverage. I would imagine there are plenty of attorney's out there who would take this type of case for free. We can lobby our government as much as we want to get insurance reform and I think eventually it will happen - but meanwhile we shouldn't stand by and watch our loved ones die over something that is preventable. Good luck to everyone and keep on trying!

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» left by Anonymous (201 days 12 hours ago.)
I want to know straight up if medicaid does cover the GB surgery?

I have read old and new posts all over the internet about medicaid and medicare does cover the surgery and does not cover the surgery,which one is it ??????????????????????????????????????????

I have been battling my over weight for the past 23 years. It was like in my younger years my weight was never a issue. Later in life I found out that I would have to be a single parent and that my parents would divorce and when this took place my weight problems began and all hell broke loose. Yo yo dieting for the last 23 years is no joke and it is very very dangerous. It has truly taken a toll on my body and to this day I am paying the consequences for it. I feel that I am fighting for my life now and I am running out of time and options. I don't know what else to do at this point and I am very tired.

I read on this post that the GB surgery can be done for "FREE" in Canada. Where in the world is this done at ? When someone finds out don't be stingy let me know :0)

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» left by Anonymous (191 days 3 hours 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 (40 days 20 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 (40 days 14 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 (16 days 11 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 (20 days 18 hours ago.)

Melissa, you must be skinny.

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» left by Anonymous (16 days 15 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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