Best answer: How overweight do you have to be for insurance to cover bariatric surgery?

Is there a weight limit for bariatric surgery?

To be eligible for bariatric surgery, you must be between 16 and 70 years of age (with some exceptions) and morbidly obese (weighing at least 100 pounds over your ideal body weight and having a BMI of 40).

What are the requirements for insurance to cover weight loss surgery?

How to get weight loss surgery covered by insurance

  • Be over the age of 18.
  • Have a BMI of 40 or greater, or have a BMI of 35 or greater with a comorbidity such as diabetes or hypertension.
  • Diagnosis of morbid obesity.
  • Pass a psychological evaluation determining you’re emotionally fit to undergo weight loss surgery.

Can you be denied for bariatric surgery?

Further, getting a pre-authorization for surgery is not always successful. While some patients may be denied coverage due to a clerical error or a technicality which can be overturned, other patients may not be deemed candidates for bariatric surgery by their insurance company and therefore not have coverage.

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What qualifies you for weight loss surgery?

To be eligible for weight-loss surgery, you must meet the following requirements: Have a body mass index (BMI) of 40 or higher, or have a BMI between 35 and 40 and an obesity-related condition, such as heart disease, diabetes, high blood pressure or severe sleep apnea.

What BMI is too high for bariatric surgery?

Learn your body mass index

A BMI range of 18-24.9 is considered optimal. Morbid obesity is defined as a BMI score of 40 or more. You typically qualify for bariatric surgery if you have a BMI of 35-39, with specific significant health problems like Type 2 diabetes, sleep apnea or high blood pressure.

What if your insurance doesn’t cover bariatric surgery?

If your insurance does not provide coverage for bariatric surgery, there are other options available to you. Depending on plan language, consultations, nutritional counseling and pre- and post-operative tests, labs and follow-up visits may be covered, although surgery is not.

How much does gastric sleeve cost out of pocket?

The average cost of gastric bypass surgery is $23,000, the average cost of lap band is $14,500, and the average cost of sleeve gastrectomy surgery is $14,900. So before getting too involved, spend time determining if your insurance will cover weight loss surgery.

How much does bariatric surgery cost out of pocket?

According to Obesity Coverage, a bariatric surgery information site, the average cost of lap-band surgery is $14,500, while gastric bypass costs an average of $23,000. The price tag might be gulp-inducing to you, and that’s understandable; it’s more than some new cars cost. However, it can be well worth the investment.

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What insurance pays for gastric sleeve?

Many PPO insurance providers are now providing coverage for Gastric Sleeve, Gastric Bypass, Distal Bypass and Lap-Band Removal. Aetna, Anthem Blue Cross Blue Shield, Cigna, Oscar, Tricare and United Health Care typically cover weight loss procedures.

Do insurance companies cover bariatric surgery?

Most personal insurance plans do not cover weight loss surgery at this point in time. However, if weight loss surgery at a private clinic is the best option for you, there are several financing options available to apply for. You may also quality for a federal medical tax credit for medically necessary procedures.

How do I convince my doctor I need bariatric surgery?

Ask your primary-care doctor or gynecologist for a referral to a weight loss surgeon. They’ll likely have patients who have undergone weight loss surgery, seen their success, and can help guide your choice of surgeon.

What medical conditions disqualify you for bariatric surgery?

These are as follows:

  • Drug and/or alcohol addiction.
  • Age under 16 or over 75.
  • History of heart disease or severe lung problems. …
  • Chronic pancreatitis (or have a history of this).
  • Cirrhosis of the liver.
  • Autoimmune disease such as systemic lupus erthyematosus.
  • Blood disorder which increases your risk of heavy bleeding.