Q. Is bariatric surgery covered by insurance, and what are the costs involved?
Doctor Answer is medically reviewed by SecondMedic medical review team.
Whether or not bariatric surgery is covered by insurance depends on several factors, including your insurance provider, your specific insurance plan, and the criteria set by the insurance company. In many cases, insurance companies may cover bariatric surgery, but they often have strict requirements and guidelines that individuals must meet to qualify for coverage. Here are some important points to consider regarding insurance coverage and costs associated with bariatric surgery:
1. Insurance Coverage: Some insurance plans, especially those provided by employers, offer coverage for bariatric surgery. However, this coverage may come with specific conditions, such as meeting certain BMI and medical criteria, attempting and failing at non-surgical weight loss methods, and obtaining pre-authorization from the insurance company.
2. Pre-Approval: It's crucial to contact your insurance provider before pursuing bariatric surgery. They can provide you with information on their specific requirements and the documentation needed for pre-approval. Failure to obtain pre-approval can result in the denial of coverage.
3. Out-of-Pocket Costs: Even with insurance coverage, there may still be out-of-pocket costs associated with bariatric surgery. These costs can include deductibles, copayments, and coinsurance. The exact amount will depend on your insurance plan.
4. Non-Covered Expenses: Some aspects of bariatric surgery, such as certain diagnostic tests, psychological evaluations, and nutritional counseling, may not be covered by insurance. You should clarify with your insurance provider what is and isn't covered.
5. Surgeon and Hospital Selection: Your choice of surgeon and hospital can impact costs. Some surgeons and facilities have contracts with insurance companies that may affect the amount you pay.
6. Post-Operative Costs: After surgery, there may be additional costs for follow-up appointments, nutritional supplements, and other necessary items.
7. Appealing Denials: If your insurance company denies coverage initially, you have the right to appeal the decision. It's important to work closely with your healthcare provider and insurance company to provide the necessary documentation and support for your appeal.
8. Self-Pay or Financing: If you do not have insurance coverage or if you do not meet the criteria, you may need to consider self-pay options or financing through loans or payment plans offered by the surgical center or hospital.
9. Tax Deductions: In some cases, medical expenses related to bariatric surgery may be tax-deductible. Consult with a tax professional to understand potential tax benefits.
It's essential to thoroughly research your insurance policy, understand the coverage provided, and communicate with your healthcare provider and insurance company throughout the process. Additionally, each bariatric surgery program may have its own billing and financial counseling resources to assist you in navigating the costs and insurance-related aspects of the procedure.