Access to Care: Which Weight Loss Surgeries are Covered

Posted by Jason Radecke on Mon, Apr 16, 2018

With insurance companies selectively choosing which people and surgeries they cover, it can be hard to tell if you qualify. Access to care for bariatric surgery is more restricted than people think with 25% of patients considering bariatric surgery getting denied insurance coverage three times before getting approval. Health conditions can worsen for those who are waiting; and continuously reapplying for coverage can delay rehabilitation for a patient even further.  

New Legislation

The Centers for Medicare & Medicaid Services (CMS) established a national coverage policy for bariatric surgery to help reduce significant health risks associated with obesity. This means every state’s insurance companies must provide coverage for these life-saving weight loss surgeries. The FDA also lowered BMI requirements in February 2011 for gastric banding with Lap-Band® for individuals with a BMI between 30 and 40 with at least one obesity-related condition.

Many states have also introduced extra coverage laws that can make it even easier now for those to gain access to this care. For example, laws in Georgia, Indiana, Maryland and Virginia recommend the insurer offer coverage for additional premiums for bariatric surgery so the application process may be more lenient than other states.

Regulations that expand coverage make it easier for patients to receive funding than before where they may have been deeply in need but didn’t qualify. The population of those who are morbidly obese continues to grow each year and federal regulations on care should change with it. More and more people are seeking bariatric surgery to live a healthier lifestyle, and insurance companies should view it as a priority.

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Weight Loss Surgeries That are Covered

The insurance plans that do have bariatric surgery in their policy usually have a standard list of surgeries they cover. These include, but are not exclusive to, Gastric Sleeve Surgery, Roux-en-Y Gastric Bypass, Lap-Band, Duodenal Switch, and the Biliopancreatic Bypass (Scopinaro Procedure). These are considered the standard in bariatric surgery, so if you suffer from this disease and your insurance offers coverage for these, you should be in luck.

There are also some surgeries that may be covered depending on your specific plan and these are: Revision Surgery (either Lap-Band Revision or Gastric Bypass Revision). Although to be approved, a patient usually must undergo a review of their weight loss attempts, current BMI and a psychology evaluation.

Obesity is the leading cause of preventable death in our society, yet access to care has been limited for a long time. Weight loss surgeries are the only documented sustainable weight loss program for those suffering with this disease, demonstrating that it is a medical necessity and not a cosmetic surgery “want.”

The surgeons and the team at Riverside Surgical and Weight Loss Center are passionate about helping you realize your goals for weight loss and health improvement. Come meet with Dr Domkowski and Radecke and see what type of surgery best fits your needs and goals for a healthier lifestyle. Contact us to get started on your weight loss journey today!

Tags: Weight Loss Surgery Covered by Insurance

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