Can I Buy Insurance to Cover Bariatric Surgery?
Someone asked me the other day. Can I Buy Insurance to Cover Bariatric Surgery? Yes, you can buy insurance to cover bariatric surgery. In fact, there are many options available to you. However, not all plans are created equal and some may have more limitations than others. Read about cutting and Selling of Toes in Zimbabwe – Secret Untold.
You can buy insurance to cover bariatric surgery from your employer, former employer or parents. Bariatric surgery insurance is also available through state medical programs, Tricare and VHA plans for veterans. Depending on the plan you choose, some hospitals and doctors may not be included as an option when buying insurance to cover bariatric surgery.
Weight loss surgery is a procedure that reduces weight and treats obesity; it’s considered a “cosmetic” procedure by most insurers. As such, weight loss surgery is covered by insurance but only if it’s medically necessary–and not just any kind of surgery will do. The insurance will cover the cost of prescription drugs too–but only if they are prescribed to help with weight loss and are medically necessary.
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In order to qualify for bariatric coverage, you’ll need to provide a list of documents proving your eligibility including proof that the surgery is medically necessary and that you have medical co-pays set up for the procedure in advance. If your claim is denied after submitting all of the required information, don’t worry–there’s an appeals process which must be followed before a final decision can be made on your case.
Bariatric surgery is a life-changing procedure that can help you lose weight and improve your health. If you’re considering surgery, make sure to check with your insurance company to see if they will cover the cost. And remember, there are many options available to you, so shop around and find the plan that’s best for you.
Can I Buy Insurance to Cover Bariatric Surgery?
States Where Insurance is Required to Cover Bariatric Surgery
What are the States that required insurance to cover Bariatric Surgery? As of 2018, the following states have passed laws requiring insurance companies to cover bariatric surgery for all plans:
- Idaho
- Indiana
- Iowa
- Kansas
- Louisiana
- Maryland
- Michigan
- Minnesota
- Mississippi
- Missouri and North Dakota.
- Georgia
- Indiana
- Virginia
- Wyoming
Medicare and Medicaid Coverage of Bariatric Surgery
The Affordable Care Act, also known as Obamacare, mandated that Medicare and Medicaid cover bariatric surgery for some patients. This means that if you meet the qualifications set by these government programs, they will cover your surgery costs.
There are a few things to keep in mind when it comes to Medicare and Medicaid coverage of bariatric surgery:
- First, all patients must be referred by a doctor before they can have weight loss surgery covered by either program.
- Second, not every surgeon accepts Medicaid due to its low reimbursement levels. However, many surgeons do accept Medicare because its reimbursement rates are higher.
- If you are covered by Medicare Advantage, contact your insurance company directly to see if your chosen surgeon is in their network.
How to Get Insurance to Cover Bariatric Surgery
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Age 18 or Older
If you are age 18 or older, CIGNA will cover bariatric surgery. You must meet the medical necessity to qualify for the benefit under most plans, with a dollar maximum if necessary. State mandates and Affordable Care Act rules impact the ability to apply a dollar maximum. A BMI of more than 40 is required for eligibility. A patient must have a BMI of 35-39.9 but also a type 2 diabetes or pulmonary hypertension to be eligible for coverage. Patients must participate in weight management programs within the last two years
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Body Mass Index Above 40
In order to be a candidate for bariatric surgery, an individual’s BMI must be 40 or greater. However, there are some exceptions. For example, if the individual has other obesity-related co-morbidities such as type II diabetes or cardiovascular disease, then their BMI may be lower and they may still be considered for surgery. Additionally, insurance companies often require that patients have been enrolled in a weight loss program for 3 to 6 months before surgery is approved. This helps ensure that the patient is motivated to make lifestyle changes and improve their health after surgery.
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Past Attempted Weight Loss
You’ll need to show documentation of previous attempts to lose weight as well as your current diet and exercise regimen. This is important because insurance companies want to see that you’ve made a concerted effort to lose weight before they agree to cover bariatric surgery.
Your health history, including any health conditions you have, will also be taken into account when determining whether or not you’re a good candidate for bariatric surgery.
Finally, you must meet certain requirements for BMI, and health issues, and have attempted for years to lose weight through diet and exercise. If all of these boxes are checked off, then Medicare may cover some weight-loss surgeries, including laparoscopic banding surgery and gastric bypass surgery but only if you’re deemed severely obese with a BMI of at least 35.
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Psychological Evaluation
When patients want to get insurance coverage for bariatric surgery, they can expect a psychological evaluation. The specific criteria that insurance providers use vary from provider to provider. However, most providers require some sort of psychological screening in order to assess the patient’s mental state and ensure that they are mentally capable of handling life after weight loss surgery.
Patients who meet standard NIH weight criteria may be eligible for insurance coverage, but this varies by company and is subject to the company’s medical plan.” In order to increase one’s chances of being approved for surgery, it might be necessary to undergo a psychiatric evaluation prior to the surgery. This will help determine whether or not the patient is emotionally ready for such a drastic change.
CIGNA is a plan which requires a 6-month supervised diet before surgery. United/MAMSI/MDIPA/Optimum Choice Federal all require 6 months (or two 3-month) supervised diet before surgery.
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Quit Smoking and Avoid Substance Abuse
Most insurance companies require that patients not have a recent history of substance abuse. This is because patients who have abused drugs or alcohol in the past are more likely to experience complications after surgery.
Preference is given to a patient seeking surgery to use their insurance in order to avoid the high hospital and other related costs associated with bariatric surgery.
The hospital will advise you on the total cost and available payment plans for bariatric surgery. If you do not have insurance, or if your policy does not cover bariatric surgery, there are still ways for you to pay for the procedure.
If a patient has insurance coverage for a related procedure, like gall bladder removal, the hospital might be able to reduce the overall cost of their surgery.
Can I Buy Insurance to Cover Bariatric Surgery?
You can buy insurance to cover bariatric surgery from your employer, former employer or parents. Bariatric surgery insurance is also available through state medical programs, Tricare and VHA plans for veterans. Depending on the plan you choose, some hospitals and doctors may not be included as an option when buying insurance to cover bariatric surgery.
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