Bariatric Surgery Insurance Coverage

Bariatric Surgery Insurance Coverage

Bariatric Surgery Insurance Coverage

Even though most healthcare companies cover bariatric procedures – bariatric surgery insurance coverage will depend if there is a bariatric surgery benefit on the specific health care plan.

In regards to bariatric surgery health insurance plan coverage  we strongly encourage our patients to call their health insurance providers and verify:

  • whether bariatric surgery is covered by your health insurance plan policy (or is it a “contract exclusion”);
  • what percentage of the facility and physician’s bill will be patient’s responsibility (copays, co-insurance, deductibles)

Our practice currently accepts the following insurance plans:

  • Aetna
  • AvMed
  • Best Choice
  • Medica
  • GHI
  • Coventry
  • Care Plus
  • Cigna
  • Simply Healthcare
  • Medicare
  • Florida Blue
  • Humana
  • United Healthcare
  • UMR
 

If you do not see your insurance plan on the list, please, call us – we most likely accept it. Bariatric surgery insurance coverage requirements sometimes are hard to understand. Please don’t hesitate – call the office and our Insurance Specialist will gladly help you to verify your benefits.

Insurance Criteria

Even though each insurance company has their own written bariatric surgery policy and requirements here are some of the most common criteria:

  • Letter of medical necessity from your primary care doctor
  • Nutritional Consult or a series of monthly nutrition consults (up to as many as 9 months)
  • Evaluation from a psychologist and/or psychiatrist
  • Documentation of failed medically supervised diet for minimum of two years
  • Medical clearance

Obamacare and Bariatric Surgery

Weight loss surgery guidelines for Obamacare require insurance companies to provide coverage for all individual, family and Small Group plans (plans with 50 or fewer full-time employees) ONLY IN STATES where bariatric surgery can be called an “Essential Health Benefit”.

Essential Health Benefits are determined in each state based on a health insurance plan that legislators find to be the most representative of the “average” plan in the state. Unfortunately, in the state Florida insurance companies are NOT required to include weight loss surgery through Obamacare. Therefore, if you live in Florida and have health coverage through Affordable Care Act obesity surgery is not covered. Please visit our page and get more information about possibly using a Self Pay option.

Medicare and Medicaid

Medicare covers bariatric surgery as long as all the necessary medical criteria are documented. Our Insurance Specialist will go over the list of criteria needed in order to go ahead with the procedure. General information about bariatric surgery coverage on cms.gov.

Straight Medicaid plans unfortunately do not cover bariatric surgery in the state of Florida. However, if you are enrolled in a Humana Medicaid or United medicaid plan your bariatric procedure will be covered if you meet the required criteria.