Is Weight Loss Surgery Covered by insurance?

If you are considering getting surgery from a weight loss clinic in Arizona, there are so many variables to consider. There is the mental preparation, the time off work, and arranging for help at home during your recovery. However, one of the biggest—and most intimidating—aspects to consider is how to pay for weight loss surgery in Phoenix.

For the majority of people struggling with obesity, paying for any form of bariatric surgery out of pocket isn’t feasible. Despite this, it is often a necessity, the last hope that morbidly obese individuals have for getting healthy.
One of the best and easiest ways to make bariatric surgery affordable is maximizing your health insurance benefits. But will your insurance cover weight loss surgery?

Is Weight Loss Surgery Covered by insurance?

Insurance Coverage of Weight Loss Procedures

Every insurance company has its own policies regarding coverage of bariatric surgeries. Generally speaking, most will offer at least partial coverage of gastric bypass, sleeve, and band for patients who meet specific requirements. However, not all will.

To find out if your provider will cover it, start by seeing if obesity is covered. Call the number on the back of the insurance card and then give them one of two codes:
• E66.01 for morbid obesity, BMI over 40
• E66.0 for obesity, BMI unspecified

With the right code, the customer representative should be able to determine what your policy covers for obesity treatment, including surgery.

When Weight Loss Surgery Is Covered by Insurance

If you are told that your policy does cover bariatric surgery, understand that this doesn’t mean it is covered in full or that it is covered for everyone. Start by asking the customer representative how much of the surgery is covered. This might be a percentage or up to a set dollar amount.

Next, ask them what criteria you need to meet for coverage and who has to verify that you do. Typically, the criteria insurance companies set for covering bariatric surgery are the same as those your surgeon will set to even consider you as a candidate, so they aren’t too difficult to meet.

Your insurance company will likely require that your primary care doctor send a referral form and documents that show your health history. Some may specifically request information about how you have attempted to lose weight in the past, ensuring that surgery isn’t your first course of action. Then, they will ask that your bariatric surgeon document that you meet the criteria for coverage.

Criteria for Phoenix Weight Loss Surgery

The most common criteria insurance companies require patients to meet before they cover weight loss surgery include:
• Being 19 or older
• Having a BMI of 40 or over OR having a BMI of 35 or over with additional health complications
• Passing a psychological exam
• Not smoking
• Agreeing to a weight loss plan before or after surgery
• Documented efforts to lose weight without surgery

If you are worried about navigating the insurance process for your lap-band in Phoenix or getting the sleeve covered, don’t worry; our billing department will help. Schedule your consultation so we can review your policy and maximize your coverage.