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How Do I Know If Insurance Will Cover My Weight Loss Surgery?

Mar 25, 2022

Many patients want to know if insurance will cover their weight loss surgery because of its cost. The weight loss surgery insurance process can be challenging to navigate. All insurance companies do not have the same policy, and plans vary by company and plan. However, generally, the majority of health insurance companies will cover at least a portion of your bariatric surgery if it is considered a medical necessity, provided the patient meets their requirements.

Insurance companies can cover your weight loss 
The best option to ascertain if your insurance policy will cover your bariatric surgery is to contact your insurance company. Most health insurance companies will cover your bariatric surgery if you meet their criteria and provide evidence that the bariatric surgery is necessary for your health. 

The Nicholson Clinic accepts and files most major insurance plans. Our Insurance Specialists contact your insurance company on your behalf to verify coverage, help you minimize your out-of-pocket expense and maximize coverage for your procedure. We help our patients easily manage the process, working directly with their insurance provider to acquire approval. 

Health insurance requirements for surgery
Health insurance companies have unique requirements before they decide to cover your weight loss surgery. Some criteria you may have to fulfill.

The patient must;

  • Have a body mass index (BMI) over 40, confirmed by your physician or BMI over 35 with one or more of the following:
    • Clinically significant obstructive sleep apnea
    • Coronary heart disease
    • Medically refractory hypertension
    • Type 2 diabetes
  • Be willing to complete a medically supervised weight loss program
  • Have a properly documented history of weight loss effort
  • Conducted and passed psychological evaluation confirming you can successfully go through the bariatric surgery
  • May be required to meet with a dietician, and you may also be required to do a sleep study

These requirements are very helpful as they set you up for success and make sure you are prepared for the changes that come with surgery. The Nicholson Clinic has all the resources you need in our office to make the process as fast and convenient as possible.

Conclusion
Many insurance companies have conditions you will need to complete before being approved for weight loss surgery. The good news is that most required appointments can be done via Telemedicine and there is no need to miss work.

In instances where your health insurance doesn’t offer bariatric coverage, don’t be discouraged. The Nicholson Clinic has other options, such as financing so you can pay a low monthly fee that fits your budget.

Schedule an appointment and let the Nicholson Clinic contact your insurance to verify coverage. Our Insurance Specialists will check your benefits and then give you a call before your consultation so you know what to expect.

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