Healthy Tidbits

With You All The Way

Will insurance cover my weight loss surgery?

Jan 17, 2014

Covering the cost of weight loss surgery is a top concern for many patients. While a patient may realize the potential health benefits of weight loss surgery, whether or not insurance will cover the cost of the surgery can be a deciding factor.

Insurance companies will typically cover the cost of bariatric surgery as long as the patient meets insurance requirements. These requirements generally include a body mass index (BMI) of at least 35 with underlying health conditions, or a BMI of 40+ with no underlying health conditions.

Most insurance companies also require that the patient goes to a counseling session and meets with a dietician. Some insurance companies also require that the patient undergoes a sleep study prior to approving coverage for weight loss surgery.

There is a difference in coverage when it comes to LAP-BAND surgery. In general, about 50 percent of insurance companies will cover the LAP-BAND/REALIZE Band procedure if requirements are met and a Letter of Medical Necessity stating why significant weight loss is medically necessary is provided to the insurance company. Some states have laws requiring insurance companies to grant benefits for weight loss procedures, as long as the patient meets the criteria of the National Institutes of Health (mentioned above). However, comprehensive and detailed attention is usually needed in order to obtain insurance coverage for LAP-BAND/REALIZE Band surgery, which we will work diligently with you to complete.

What is a Letter of Medical Necessity?

A Letter of Medical Necessity addresses why weight loss is pertinent to your health. Information in this letter includes: diets and/or weight loss programs you’ve tried in the past; your current weight; a BMI of at least 40 or 35 to 40 with underlying health issues; the number of years you have been overweight (generally five or more); and your full medical history related to obesity including hypertension and type 2 Diabetes.

Which insurance companies cover weight loss surgery?

Insurance companies that provide partial or complete coverage include: Blue Cross (in some states), Humana First Health, Medicare, United Healthcare, Aetna, Cigna, Luminos, and PHCS. If you are unsure if your insurance company will cover the procedure, check with your employer’s human resource department or fill out an application with The Nicholson Clinic and our insurance verifier will look into your options.

It is important to remember that every insurance company is different, so talk to your provider to get details on coverage.

Which insurance companies does The Nicholson Clinic accept?

The Nicholson Clinic accepts most major insurance plans, not including Medicare. If your insurance does cover the cost of your weight loss surgery, you will be responsible for deductibles and co-pays. If you have a Flexible Spending Account, you may be able to use these funds to cover deductibles, co-pays and other out-of-pocket costs.

We are committed to helping every patient get the weight loss surgery they need — no exceptions. If you do not have insurance or if your insurance does not cover bariatric surgery, we offer a cash price and flexible payment plans through a third-party financer with monthly payments as low as $236.

If you are considering bariatric surgery, but are concerned about the cost, we have patient care advocates on staff to help you manage the process, whether you use insurance or choose to pay for the surgery yourself. It is our commitment to help every patient get the weight loss surgery they need, without exceptions. To accomplish that goal, we also offer flexible payment options with monthly payments starting as low as $236.