If you’ve been considering the benefits of weight loss surgery (also known as bariatric surgery), you’re probably thinking about how to pay for it, too. Whether your health insurance will cover all or part of the cost of the surgery can be a huge factor in your decision.
Your coverage and out-of-pocket health expenses are specific to your insurance policy and company. Some companies cover treatment options for the disease of obesity, while others carve it out of the policy because it helps to reduce the premium cost for all employees and family members covered under the policy. It’s important to understand the insurance requirements to qualify for bariatric surgery coverage so you can plan and take the right steps.
What insurance companies consider
Many insurance companies have criteria for patients to meet before approving coverage for bariatric surgery. These include:
- Medical Necessity. Your insurance company may request documentation from your surgeon or primary care doctor showing that bariatric surgery is medically necessary for your health based on your weight health conditions related to obesity.
- Body Mass Index (BMI) Criteria. Your insurance company may ask your physician to verify your BMI and other health complications. Most policies require that the patient have a BMI of 35 or greater. For those with a BMI less than 40 they usually must already have developed an obesity related health problem. Some examples of obesity related conditions are high blood pressure, high cholesterol, type 2 diabetes, sleep apnea, heartburn, and back or joint pain. You can calculate your BMI by entering your height and weight into a BMI calculator on our website.
- Documentation of Weight Loss Journey. You may be asked to provide records of other ways that you have attempted weight loss. For example, your insurance company may request that you seek nutritional counseling or participate in a medical weight loss program for a set period of time before you qualify for coverage for bariatric surgery.However, you can be working towards this in our program while you work towards a surgery date. Our program has dedicated registered dietitians and therapists who can help you start working toward weight loss as you prepare for surgery.
Questions to Ask Your Insurance Company
Not all insurance plans cover weight loss surgery, and even if they do, you might need to meet specific qualifications. It’s important to talk to your insurance company and learn what is and is not included under your plan.
Some questions to help that conversation include:
- What coverage is offered for weight loss surgery under my insurance plan?
- What requirements do I need to meet before qualifying for insurance coverage for weight loss surgery?
- What can exclude me from qualifying for bariatric surgery?
- Most insurance policies require that you have weight loss surgery at a nationally accredited bariatric program because their clinical outcomes are superior and offer education and support services that help patients maximize their weight loss. You may want to ask them if they can provide you with a list of accredited bariatric programs in your area.
- What copay, deductible or out-of-pocket maximum limit would I need to pay for this surgery?
Resources for your weight loss Journey
The care team at Northeast Georgia Medical Center (NGMC) Bariatric Weight Loss Center is experienced at navigating the complexities of insurance companies and individual policies. They are here to support you and work with your insurance company to make sure you have the documentation they need to decide on your coverage.
If you’re insured through the Georgia State Health Benefit Plan, bariatric surgery is included as a covered benefit.
Zero percent interest payment plans are also available to help manage the cost of bariatric surgery over time. You can pay for the surgery in advance in monthly payments over a year. If you’re interested in pursuing a payment plan, be sure to ask your physician’s office for more information.
Next steps
NGMC’s Bariatric Weight Loss Center is here to partner with you in your weight loss journey, whether that means surgical or nonsurgical treatments. To learn more about bariatric surgery and what options are available to you, call 770-219-0446.