Does Insurance Cover Gastric Sleeve Cost?

 Does Insurance Cover Gastric Sleeve Cost?

The gastric sleeve cost is typically covered by insurance for individuals who meet specific requirements. The first requirement is to have your doctor or surgeon fill out the necessary forms to request authorization from your insurance company. Next, they will review whether or not you are eligible for coverage based on their guidelines. If both of these steps are completed successfully, the only remaining cost would be the deductible and any co-payments that apply to your particular plan.

The insurance typically includes those individuals who have a Body Mass Index (BMI) of 40 or greater. However, the cost is not covered in full. There are usually several other requirements that must be met to get your weight loss surgery covered, such as having no history of significant complications from surgery within five years. Other conditions can include having a doctor fill out all the necessary forms for you and ensuring that they have completed your pre-operative workup.

There is another option for those who do not have insurance coverage or whose plan does not cover the cost of a gastric sleeve surgery. Some businesses provide financing options to help patients pay for this procedure without waiting until they receive their reimbursement from an insurer. They work with surgeons and hospitals to get you approved for credit. You can then use this financing program to pay for the surgery in monthly installments over some time, resulting in lower costs per month than if you were to make all the payments at once upfront.

If you are interested in learning more about your gastric sleeve and insurance coverage options, contact Dr. Feiz today. They will be able to assist with all of your concerns so that you can receive the medical care necessary for optimal weight loss results.

List of Insurances Covering Gastric Sleeve Cost

  • Medicare.
  • U.S. Department of Defense Military Insurance.
  • TRICARE (for military members and their families).
  • Veterans Affairs Medical Insurance for veterans and dependents.
  • Indian Health Service insurance coverage for Native Americans living on reservations or in designated areas is part of the Affordable Care Act (Obamacare).
  • Individual insurance that covers gastric sleeve cost as an option includes Blue Cross or Blue Shield of Texas, Aetna, Cigna, Anthem; Coventry Health & Life Insurance Company; United Healthcare Community Plan; First Choice Health Network; Molina Healthcare, and Humana Medicare Supplemental Plans. These are private pay plans that are not part of Medicare Advantage or Medicaid.
  • Employer and Union Insurance Plans – only if your insurance is through an employer, check with human resources to see if gastric sleeve surgery is a covered benefit.
  • HMOs or Health Maintenance Organizations – these are insurance plans where you must use a provider within the network, which generally will not cover surgery outside of the network.
  • Workers’ Compensation Insurance Plans – these are insurance plans for employees who may have experienced an injury at work, which do not provide coverage for medical costs resulting from surgeries such as a gastric sleeve or lap band surgery.

FAQs

What insurance covers weight loss surgery?

The best way to find out if your insurance covers weight loss surgery is by contacting the company directly. Most policies will cover at least part of a bariatric procedure, but determining what that portion entails requires checking with them directly.

However, not all surgeries are covered by insurance. For example, if your doctor recommends a gastric sleeve, you will want to determine how much of the procedure is covered before making any decisions about whether or not to go forward with it. A lap band surgery cost might be an alternative that does have more coverage through health plans in your area.

How long does it take for insurance to cover gastric sleeve?

It is one of the most common questions we get. The answer: it depends. Not every procedure will garner coverage, and some surgeries may not be covered in full. Schedule an appointment with your primary care physician to know if you are a good candidate for this procedure. Once you are cleared for bariatric surgery by your PCP, the next step is to obtain a referral from them to verify insurance coverage.

Is it hard to get approved for gastric sleeve?

A gastric sleeve is an effective weight-loss surgery that insurance can cover only if certain conditions are met. Insurance companies can set guidelines for gastric sleeve surgery. These include the patient’s BMI, based on height and weight that is used to measure fatness. Insurance companies may also require patients to lose some weight with dieting or behavioral therapy before approving them for bariatric surgery.

Jason

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