If you're a candidate for weight loss surgery, you may be planning to undergo the procedure and shed excess weight. One of the most common questions many people have with weight loss surgery is if it's covered by insurance. There are a few important facts to understand to determine if your insurance will cover the costs to ensure you can move forward with bariatric surgery.
Every Insurance is Different
Every insurance company is different in the coverage it offers, making it necessary to look into your policy. If your insurance covers bariatric surgery, there are a few requirements to be eligible for the surgery. The criteria often include having a serious health condition due to your weight or having a body mass index that exceeds 40. You may also be approved for bariatric surgery if you've had unsuccess with other types of medically-approved weight loss procedures.
States That Requires Insurance
There are a few states throughout the U.S. that require you to have insurance to obtain the surgery. Some states may also require insurance companies to offer other procedures that are less invasive. The current states that require insurance include Colorado, Arizona, California, Rhode Island, Wyoming, New Jersey, New Hampshire, Massachusetts, Iowa, Hawaii, Delaware, Nevada, New York, Vermont, South Dakota, North Carolina, Michigan, West Virginia, and New Mexico.
The Cost of Weight Loss Surgery with Insurance
There are typically out-of-pocket costs to pay even when your insurance covers weight loss surgery. First, you'll need to have the surgery approved by your insurance provider. The coinsurance rates of your policy will also determine how much you can expect to pay. Many people have an 80/20 split for the rates, which means you'll be expected to pay 20% of the overall cost of the surgery. You may also need to meet your annual deductible to have access to the coinsurance rates.
The Cost of Weight Loss Surgery Without Insurance
If you don't have an insurance policy or your current provider doesn't cover the cost of the procedure, you'll be required to pay 100% of the costs out of pocket. Weight loss surgeries range from $15,000 to $25,000.
The different factors that influence the overall cost include the type of surgery that needs to be performed and if it's invasive. The surgeon that performs the surgery will also dictate the cost. You'll likely pay more for their services if you have the surgery in a city that has a high cost of living. The medical professional's level of experience is another factor that determines their rates.
The location where the surgery is performed is another factor in the overall cost. The price varies, depending on the hospital where the surgery is performed and how much they charge for their operating rooms.
There are several ways to reduce the cost of the surgery if you have to pay for it out-of-pocket. Call different surgeons in the local area to obtain multiple quotes and prices. You can also reach out to different operating rooms and hospitals.
Additionally, consider getting a different type of weight loss surgery, but it should be approved by your primary care physician. Not all weight loss surgeries are ideal for different types of people.
Getting Your Weight Loss Surgery Approved By Your Insurance
If your insurance plan covers weight loss surgery, you need to work with your medical provider to determine if you meet the criteria to be a candidate. If you currently don't meet the specific criteria in place, you can always consider changing your plan during the open enrollment timeframe.
Start by looking for a qualified surgeon that specializes in weight loss surgeries in the local area. The medical professional will need to be approved by your health insurance to ensure the costs are covered. Once you find the right surgeon, they'll provide you with a list of the costs associated with weight loss surgery, including the amount that you'll need to pay out-of-pocket.
What to Do if You're Denied By the Insurance Company
If your insurance company doesn't consider you to be a candidate for weight loss surgery and declines the coverage, you'll need to find a way to prove the surgery is necessary to your health and well-being. Work with your primary physician to determine which conditions or ailments you're suffering from are a result of your weight. You'll be asked a series of questions, and your BMI will be tested.
You may also be required to try other types of weight loss methods and programs before you qualify for surgery. Consider enrolling in a weight loss program that is supervised for several months to try and meet your weight loss goals. Try to find a program that your physician refers you to, which will allow them to communicate to your insurance if it proves to be unsuccessful.
If you're interested in getting weight loss surgery, feel free to contact Miami Sleeve Center in South Florida. We can answer your questions and also assist you with scheduling an appointment for a consultation.