WILL MY HEALTH INSURANCE COVER MY GASTRIC BYPASS SURGERY?
The title of this post is a difficult question to answer. In short- sometimes. Everything depends on your current coverage, your current state of health, how adept you and your doctors are at working with insurance companies among other factors.
Insurance plans vary greatly. When it all boils down to it insurance companies are there to make money. That means many companies will do whatever possible to avoid covering expenses. Because of that, it is key that as the owner of the policy you convince the insurance agents that the gastric bypass surgery will be cheaper than the costs of treating any other obesity-related illnesses you may have currently or may experience in the future.
Generally surgeons will only perform the surgery on patients who are termed “morbidly obese.” To have the surgery done on a patient that is not morbidly obese, is often considered “elective surgery” which is viewed by insurance companies as optional. An example of “elective surgery” is plastic surgery like rhinoplasty (nose job).
Because patients usually need to be “morbidly obese” to qualify for the surgery to begin with, it generally means those patients also have other health problems like diabetes, high cholesterol, heart disease and heart failure, high blood pressure, sleep apnea, chronic acid reflux, gallbladder disease, liver disease, blood clots, back problems and joint problems.
The trick, then, is to convince the insurance company that it is cheaper to cover the cost of gastric bypass surgery than to cover all the other obesity-related illnesses.
Unfortunately, some insurance policies simply won’t cover gastric bypass surgery. Any policy that has an “exclusion” written into it for gastric bypass surgery or lap band surgery simply will not cover either procedure. If your insurance policy has such an inclusion you have a few options.
- You might be able to change your policy or upgrade your policy at your company’s open enrolment date.
- If you are married, and your spouse works, you may be able to switch to his/her policy. In the short term, this is very likely the more expensive option, but it is probably cheaper than paying for the surgery outright.
- Some bariatric surgeons will work with you to pay for the surgery out of pocket.
If you are on Medicaid or Medicare, it is unlikely that you will be covered. Since Medicaid simply does not cover any sort of weight loss surgery. Medicare will cover the surgery if there are other serious illnesses caused by obesity.
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