Is Bariatric Surgery Covered By Insurance?

If you’re trying to decide whether or not to get bariatric surgery, cost is a very important factor. Bariatric procedures in the USA typically cost well over $10,000, and most people are not able to simply pay that in cash.

As a result, the next question that most patients ask is “Does my insurance cover bariatric surgery?” Unfortunately, the answer to this question is not exactly straightforward, and finding out on one’s own will require several steps.

But first, let’s go over how bariatric surgery works with health insurance in the US.

Is Bariatric Surgery Covered By Insurance?

The simple answer to this question is “probably”. Most insurance plans cover weight loss surgery, provided that certain conditions are met before getting the surgery.

Bariatric procedures, in general, are covered as elective procedures. But not all plans cover weight loss surgery, and not all providers cover every procedure. For a long time, gastric sleeve surgery and many reversible procedures (such as Lap-Band and gastric balloon) were excluded as they were experimental procedures. Nowadays, things have changed and gastric sleeve surgery is covered by most insurance providers.

It’s still important that you check whether or not your insurance covers the procedure you want.

Here’s how to find out.

How to Check If Bariatric Surgery Is Covered By Your Provider

Step 1: Find out if obesity is covered by your individual policy

Call your insurance provider and ask if obesity is a covered benefit under your individual policy.  If so, you should be able to get bariatric surgery covered by your insurance.

ICD10 code: E66.01 (morbid obesity) or E66.0 (obesity, unspecified BMI)

Step 2: Make sure the procedure you’re considering is covered

If obesity is a covered benefit, you want to figure out whether the procedure you want is covered. Use the following codes to figure out if your insurance will cover a particular procedure:

Gastric bypass: CPT 43644

Gastric sleeve: CPT 43775

Duodenal switch (BD-DS): CPT 43645

Step 3: Ask if the healthcare centers you’re planning to use are accepted by your insurance

If you’re planning on using us, contact us and we’ll tell you what you need to say to your insurance.

Step 4: Find out the requirements for weight loss surgery insurance coverage

Most insurance companies have the following requirements for coverage:

• You must be over the age of 18. If you’re asking about an adolescent, make sure to contact your insurance provider.
• BMI over 40 OR BMI over 35 with a weight-related condition such as type 2 diabetes or hypertension
• You must have been morbidly obese for a specific period of time before surgery
• You must have documentation of weight loss attempts using diet and exercise in the past
• You must pass a psych evaluation

Other requirements may include:

• No evidence of substance abuse
• No smoking, or if you are a smoker, you must undergo a smoking cessation program before surgery

My Insurance Doesn’t Cover Bariatric Surgery, What should I Do?

Switch to another carrier during open enrollment. Do your research about available coverage options.

Pay cash for your surgery. There are options for financing your surgery, including taking out loans to do so. If you’re considering paying cash for surgery and you’re getting the procedure with us, call us at 702-637-1973 to discuss your available options.

Make sure to contact your own health insurance provider to get the actual answers to your insurance questions. None of the above is a guarantee of coverage. If you have specific insurance-related questions regarding procedures performed at Southern Nevada Bariatrics, give us a call at 702-637-1973.