Your Open Enrollment Resource for Choosing Insurance That Covers Weight Loss Surgery
Sorting through insurance documents during open enrollment can be overwhelming, especially when you are seeking benefits that cover something life-changing like weight loss surgery. Finding insurance with bariatric surgery coverage is the first step. Prior to signing up for a health insurance plan check with your HR department if the plan covers weight loss surgery. You then need to determine what the requirements are and what out-of-pocket costs you can expect, so you can be financially prepared for the journey.
At the Center for Weight Loss Surgery, we work with several major insurance providers to help make weight loss surgery possible, including Aetna, Blue Cross Blue Shield, Cigna, First Choice, United Healthcare, Kaiser Permanente, Premera and Regence.
Does Insurance Cover Weight Loss Surgery?
As you review your options during open enrollment, you’ll find that most insurance plans cover bariatric surgery, though the criteria can vary quite a bit. You can usually determine whether a plan covers bariatric surgery in the certificate of coverage, evidence of coverage or summary plan description. For specific requirements, like body mass index (BMI) thresholds, you may need to check an insurer’s medical policy, which is often published on their website.
If you get insurance through your employer, coverage documents are often available through your company’s employee self-service (ESS) portal. You can also call member services directly or ask your HR department for assistance.
Understanding the insurance requirements for weight loss surgery can help you avoid surprises later in the process. As you explore different plans or coverage tiers, be sure to consider the following:
- BMI requirements: Insurance plans commonly require a BMI of 40 or above or a BMI of at least 35 with one related health condition like hypertension or sleep apnea. Some plans may cover bariatric surgery for those with a BMI of 35 without qualifying comorbidities. Many plans will also cover surgery for patients with a BMI between 30 and 34.9 with a type 2 diabetes diagnosis.
- Supervised weight-management guidelines: Insurers often ask for proof of a clinician-supervised diet program, typically lasting one to three months, before approving surgery.
- Psychological requirements: Many health insurance plans require a mental health evaluation as part of the approval process. The purpose of this evaluation is to help confirm that the patient is ready to follow the care plan before and after surgery, including dietary guidelines and life-style changes.
- Out-of-pocket expenses: Look closely at the plan’s deductible, coinsurance and out-of-pocket maximum, as these vary significantly between plans and play a major role in how much someone pays for bariatric surgery.
What About Cosmetic Surgery Coverage?
Cosmetic surgeries, like a tummy tuck or lower body lift, are generally not considered medically necessary. For that reason, body contouring options are usually not covered by insurance, with a few exceptions. One type of surgery that may be covered is a panniculectomy. This option involves removing excess skin in the lower abdomen, called a pannus. Since a pannus may impact a person’s physical health, such as causing skin or mobility issues, it could be covered by insurance if it’s proven as medically necessary through chronic, documented medical issues.
We’re Here to Help
We understand that cost is a major consideration when deciding whether bariatric surgery is right for you. No matter what plan you select during open enrollment, our team will verify your insurance benefits before your consultation, so you have clarity on coverage. If a surgery isn’t covered, financing through CareCredit or Prosper can help make self-pay more manageable. We also offer discounted pricing for patients paying out-of-pocket.
Do you feel ready to take the next step? Please contact our Federal Way, WA, or Kirkland office for guidance or complete our online form to begin the insurance verification process.
