According to the CDC, the estimated population of American adults with morbid obesity is roughly 40%. The crisis of obesity is quickly becoming an epidemic in the U.S., many people are seeking to lose weight. As a result, they are curious if insurance providers might assist their road to weight loss through weight loss surgery. Procedures like gastric sleeves, bypasses, and duodenal switches are all potentially covered beneath your insurance plan. In this article, we include the basic premises and what to look for when deciding to undergo an operation with your physician’s assistance.
Diet and Exercise
Providers usually have steps before seriously considering the push for surgery. They will first require you to put some serious effort into your weight loss with diet and exercise. Begin by first, speaking with your physician and finding a routine fit for you and following it. Without effort and proof of attempts, the insurance companies will not cover your operation.
Common Prerequisites of Various Providers
With each provider, there are ‘underlying checks’ that you must pass before they consider you for coverage for surgeries. Some of the most basic are things like minimum age, which is usually eighteen but can be lower with some specific plans. Others are things like your body mass index being at least forty or lower with risk factors that will jeopardize your health further.
Before treatment, you must also have no evidence upon checkup of substance abuse. You’ll also undergo psychological testing and be required to quit smoking beforehand, so prepare for the surgery by preparing to give up nicotine. An unfortunate reality for many, but necessary for your health.
Some of the worst symptoms of obesity include:
- High blood pressure
- Sleep apnea
- Cholesterol Issues
- Fatty liver disease
- Urinary stress incontinence
With surgery, It’s been heavily documented that conditions such as these will begin drastically improving as the stress on your body lowers from your weight loss.
Some of the most common providers that Americans are using are insurance companies such as Medicare, Medicaid, CIGNA, and Aetna. Though, if you aren’t within these major companies, be sure to request a copy of your provider’s insurance policies to review them yourself. Additionally, a few calls to discuss the terms and requests for the surgery to your provider might be a good idea.
Medicare covers some surgeries, but you need to meet their BMI requirements above 35, serious health issues arising, and years of attempts to lose weight with diet and exercise. CIGNA has similar rulings regarding BMI requirements and health issues and differentiates by requiring a weight-loss program directed by a physician. They’ll also require several recommendations, evaluations, and more before paying for the procedure. Aetna’s program is roughly the same as CIGNA’s.
If They Decline You
If your provided information isn’t enough for them to warrant the surgery, you still have options to appeal. Every health insurance provider has documented materials to assist you in the appeals process; find them, study them, and follow them to the letter. Keep in mind, some providers give you a limited amount of time to appeal the process. So if you get denied, work fast to reach the next steps necessary to attempt fighting their rejection.
Average Cost of Weight Loss Surgery
The surgery’s average cost appears to be roughly anywhere between a low of $17,000 to a staggering high of $26,000. Of course, each pricing is a variable factor depending on your age, size, the operation you choose, and other factors.
Even the highest price of the surgery is still a far cheaper option than treating the various long-lasting consequences of staying within the morbid obesity bracket, as the stress of large amounts of weight upon your body will quickly cause it to break down.