How to Get Insurance to Pay for Gastric Bypass Surgery

Insurance for Gastric Bypass Surgery LA, CA
Insurance for Gastric Bypass Surgery

Introduction to Insurance for Gastric Bypass Surgery

Are you morbidly obese? Do you suffer from one or more life-limiting health conditions as a result, such as high blood pressure or type 2 diabetes? If so, gastric bypass surgery could save your life. The procedure makes weight loss easier and is becoming more popular every year.

One of the main deterrents to a procedure like gastric bypass surgery is cost. People fear the procedure is too cost-prohibitive to be a realistic solution to their ongoing weight problem. Health insurance can help in this regard. With the right policy, health insurance could pick up some or all of the tab.

Getting insurance to pay for gastric bypass surgery is not a straightforward process. You may feel like a circus animal trying to please its trainer with all the hoops the average insurer makes you jump through. The purpose of this post is to make the process easier and less stressful, allowing you to have surgery without incurring crippling out-of-pocket costs.

In this post, we will cover the specifics of gastric bypass surgery and how it can save your life. We discuss the cost of gastric bypass surgery, the fee amounts insurers are willing to cover, and how to get your health insurance provider to cover some or all of the costs ASAP.

Don’t want to wait until the end? Do you want answers now? We won’t call you impatient, don’t worry. Call Healthy Life Bariatrics to discuss your weight problem with renowned bariatric surgeon Doctor Babak Moeinolmolki. Schedule a consultation by dialing (310)881-8503.

How Does Gastric Bypass Surgery Help with Weight Loss?

Gastric bypass surgery (Roux-en-Y Gastric Bypass) is considered by many experts to be the gold standard of bariatric surgeries. The procedure has been studied and refined for over 50 years and comprises around 18% of all bariatric operations.

Roux-en-Y gastric bypass was designed to make weight loss easier for

the morbidly obese. The surgery involves certain changes to your digestive system that are conducive to weight loss. Gastric bypass surgery helps you lose weight in two amazing ways.

The first is referred to as restriction. During the procedure, the bariatric surgeon divides your stomach into two sections. The top section is converted into a small pouch, which reduces the space available for food. By limiting the capacity for food in your stomach, you are forced to eat less.

The second way the procedure helps you lose weight is by limiting your body’s ability to absorb some calories and nutrients from the foods you eat. After the stomach pouch is created, the smaller pouch is then diverted to a section of your small intestine, which causes the food you eat to bypass a majority of your stomach and the first portion of the small intestine.

This two-pronged approach to weight loss helps you slim down in record time.

Read our article: How Gastric Bypass Surgery Makes Weight Loss Easier

Who Qualifies for Gastric Bypass Surgery?

Insurance for Gastric Bypass Surgery
Insurance for Gastric Bypass Surgery

Procedures like gastric bypass surgery should be considered a last resort to extreme weight loss. Most patients who qualify for the Roux-en-Y gastric bypass procedure have spent years attempting to lose weight with diet and exercise alone but to no avail. Nothing is more frustrating than doing everything right and still seeing the same numbers on the scale. Gastric bypass surgery can alleviate this frustration.

To qualify for gastric bypass surgery, you must be obese or morbidly obese. That means having a body mass index (BMI) of 40 or greater, which amounts to around 100 pounds or more overweight. You can also be considered with a slightly lower BMI, such as 35 or even 30 if one or more obesity comorbidities are also present. Examples of weight-related ailments that can qualify you for bariatric surgery include osteoarthritis, obstructive sleep apnea, heart disease, and diabetes.

You should also be able to say yes to the question of whether you have tried to achieve a healthy weight for a lengthy period of time.

When you schedule a consultation with a bariatric surgeon, your BMI, state of your health, and psychological readiness for bariatric surgery will be assessed to determine your qualification status.

What are the Prime Benefits of Gastric Bypass? Are There Risks?

Gastric bypass surgery is usually prescribed for those on the higher end of the BMI scale. The procedure is considered slightly more effective than other popular bariatric operations such as gastric sleeve surgery. Another benefit is that the technique does not involve the placement of any foreign objects in the body, such as the prosthetic device used with gastric banding.

Aside from significant weight loss (gastric bypass surgery patients can lose up to 70% or more of their excess weight), the procedure is considered a viable treatment for obesity comorbidities. Many patients find that their weight-related ailments diminish in severity or resolve entirely once the excess weight begins melting away. Your experience may vary.

Read our article: How Much Does Bariatric Surgery Help to Control Obesity?

Risks of the gastric bypass include hernias, ulcers, and a narrowing of the intestinal connections. You may experience vitamin and mineral deficiencies, which require you to take supplements for the rest of your life. The surgery is permanent, which means it is not reversible and will prevent you from taking anti-inflammatory drugs or using nicotine products because of the risk of ulcers.

As with any surgery, potential risks of the operation include blood clots, bleeding, infection, and pneumonia.

You can reduce your chances of experiencing negative side effects by choosing your bariatric surgeon wisely. Look for a professional with board certification, decades of training, and a proven track record that includes testimonials and before and after proof of weight loss surgery success.

How Much Does Gastric Bypass Surgery Cost?

Gastric bypass costs around $15,000 on average. This may not include associated costs such as anesthesia, medical center costs, surgeon’s fees, and prescription medications.

While this amount may seem excessive, most patients consider the amount to be money well spent when they consider the life-saving aspects of this popular bariatric surgery. Another thing to consider is that healthcare costs associated with obesity will have you spending much more than $15,000 over your life span. Studies show that morbidly obese patients spend 36% more on health care and 77% more on prescription drugs than the average healthy person each year. Taking this into account, gastric bypass surgery is a much cheaper option. The procedure makes you healthier and could extend your life.

Will Health Insurance Pay for Gastric Bypass Surgery?

Insurance for Gastric Bypass Surgery Los Angeles, CA
Insurance for Gastric Bypass Surgery Los Angeles, CA

Nearly 95% of health insurance companies have a clearly defined pre-authorization policy for procedures such as Roux-en-Y gastric bypass surgery. The majority of insurers require an elevated BMI and a history of failed weight loss using traditional means (diet and exercise). But these requirements are not always sufficient by themselves to receive approval for bariatric surgery coverage.

For a health insurance company to cover some or all of the costs, you and your doctor must be able to demonstrate medical necessity. In addition to a consultation with a bariatric surgeon, health insurers usually want a letter written by your doctor that states that bariatric surgery is needed for health and longevity extension purposes. But that’s not all.

Here are the average requirements for health insurers before coverage is granted for bariatric surgery. Read your policy requirements for details that pertain to your exact situation.

The Bariatric Surgery Health Insurance Process Explained

Must be 18 Years of Age or Older

The majority of health insurance policies do not cover teenagers. That means you need to be over the age of 18 to be considered for coverage.

Body Mass Index Above 40

The insurance provider will generally want proof that your body mass index (BMI) equals 40 or above. Or that you have a BMI of 35 in conjunction with one or more obesity comorbidities.

Demonstrate Past Attempts at Weight Loss

Many health insurance providers require proof that you have attempted everything under the sun to lose weight. Some insurers require you to enroll in a medically supervised weight loss plan for three to seven consecutive months. You will then send documentation detailing your weight loss efforts to your insurer as part of the approval process.

Read our article: A Medically Supervised Diet May Be Your Key to Overcoming Obesity

Are You Psychologically Ready for Gastric Bypass Surgery?

A majority of bariatric surgeons require you to undergo a psychological evaluation before they will approve you for gastric bypass surgery. The purpose of this mental health assessment is to determine your reasons for seeking out surgical weight loss intervention. You should want to improve your health as opposed to undergoing surgery due to pressure from someone close to you, for example. The assessment also includes discussions about your weight and diet history, eating behaviors, social support system, and psychiatric history.

The bariatric psychologist’s role is to determine if you are mentally ready for surgery and that you understand how gastric bypass surgery works, and all the amazing ways your lifestyle will change following the procedure.

No Smoking or Substance Abuse

Most health insurance companies want you to be a non-smoker before they will approve you for gastric bypass surgery. They also want to ensure that you have not smoked or abused substances for the past five years before approving you for the gastric bypass procedure.

Your Bariatric Surgeon Will Help with the Insurance Approval Process

Insurance for Gastric Bypass Surgery Los Angeles, CA
Insurance for Gastric Bypass Surgery Los Angeles, CA

Bariatric surgeons and their office staff have been through the insurance approval process many times before. This makes them an excellent resource for expediting the time between applying for surgery and getting approved for the procedure you want. The doctor and staff can help you check the details of your health insurance policy and submit the necessary documentation required for approval.

What if Your Insurance Provider Declines Coverage for Bariatric Surgery?

Even if your health insurance policy covers gastric bypass surgery, the approval process could take a long time. You will need reams of documentation to prove that bariatric surgery is medically necessary for your health and longevity. You may also experience major roadblocks before approval is granted.

They may deny you, for example, if the insurer does not believe you have met all the necessary criteria. The important thing to keep in mind is that denials for bariatric surgery happen all the time. Do not give up. Appeal the decision and submit further documentation if needed to prove the medical necessity clause.

All health insurance policies come with a clear appeals process. Find out what your insurer requires and follow the directions as closely as you can. You may have a limited time from the date of denial to file an appeal. This usually amounts to 60 days. Start with a phone appeal and move to a written appeal if the phone representative cannot help.

Have You Considered Medical Financing?

What happens if you are denied coverage for gastric sleeve surgery by your health insurer? What if all your appeals have gone unanswered? Or what happens if you don’t have health insurance at all? Medical financing may be the best way to pay for surgery without breaking the bank.

In cases where your insurance policy fails to cover you, bariatric surgeons traditionally partner with medical finance companies like Care Credit. These companies allow you to qualify for a medical loan to cover gastric bypass surgery as well as pre-surgery expenses.

Ready to Take the Next Step for the Improvement of Your Health and Longevity?

Now that you are more familiar with gastric bypass surgery, the benefits and risks, the costs involved, and the insurance approval process, isn’t it time you took the next logical step?

When you have attempted all the traditional means to lose weight and nothing has worked, gastric bypass surgery can act like a magical switch. Whereas the excess weight seemed to cling to your body with abandon before surgery, the weight tends to melt away following the gastric bypass procedure. You must still do your part by living a healthy lifestyle. However, gastric bypass surgery can make you healthier and extend your life.

Get more answers and take the first step to a healthier you by scheduling a consultation with renowned bariatric surgeon Doctor Babak Moeinolmolki. Dial (310)881-8503 to get started.

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Healthy Life Bariatrics

Dr. Babak Moeinolmolki
January 2, 2023
Dr. Babak Moeinolmolki
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