Is Weight Loss Surgery Covered by Insurance in Los Angeles?
Bariatric surgery, or weight loss surgery, is not a cosmetic procedure per se—it is often a medically necessary procedure for individuals struggling with obesity-related diseases such as Type 2 diabetes, high blood pressure, and sleep apnea. Fortunately, most Los Angeles insurance providers are able to cover bariatric procedures under certain clinical guidelines.
Healthy Life Bariatrics, led by double board-certified bariatric surgeon Dr. Babak Moein, is a professional at helping patients with their weight loss surgery insurance coverage and guiding them through the complete approval process.
What Weight Loss Surgery Is Covered by Insurance?
1. Gastric Sleeve Surgery (Sleeve Gastrectomy)
One of the most prevalent and insurance-covered operations.
Coverage: Most major insurance plans like Blue Shield, Anthem, Aetna, UnitedHealthcare, and Kaiser (with referral from a specialist) cover this.
Indications: BMI ≥40, or ≥35 with medical conditions related to obesity like diabetes, high blood pressure, or sleep apnea.
Local Considerations: Los Angeles approval might also necessitate documented participation in a supervised weight loss program and psychiatric evaluation.
2. Gastric Bypass (Roux-en-Y)
Known as the "gold standard" for bariatric surgery.
Coverage: Medicare, Medi-Cal, and most private insurance plans cover it.
Best For: Those who have severe acid reflux, diabetes that's hard to control, or who have failed at diet and exercise.
Local Notes: Institutions such as UCLA and Cedars-Sinai generally approve gastric bypass under affiliated health plans when medical necessity is documented.
3. Gastric Balloon (Intragastric Balloon)
The gastric balloon is a safe, temporary, and effective non-surgical weight loss solution.
Coverage: Not typically covered by insurance because it's non-surgical and temporary.
Best For: Patients with a BMI of 30-40 who prefer not to have surgery.
Out-of-Pocket Solutions: Out-of-pocket patients can utilize financing options such as CareCredit.
| Procedure | Insurance Coverage | Ideal Candidates & Local Notes |
|---|---|---|
| Gastric Sleeve | ✅ Covered by Blue Shield, Anthem, Aetna, UnitedHealthcare, Kaiser (with referral) | BMI ≥40 or ≥35 with comorbidities. Requires supervised weight loss program and psych eval in LA. |
| Gastric Bypass | ✅ Covered by Medicare, Medi-Cal, most commercial plans (UCLA/Cedars affiliated networks) | Best for severe GERD, uncontrolled diabetes, or failed past attempts. Medical necessity must be proven. |
| Gastric Balloon | ❌ Rarely covered due to non-surgical nature. Financing (e.g., CareCredit) often required. | BMI 30–40. Temporary option. Clinics like Healthy Life Bariatrics offer out-of-pocket plans. |
| Lap-Band (Adjustable Gastric Banding) | ✅ Sometimes covered by older insurance plans; less common in modern coverage policies. | BMI ≥40 or ≥35 with comorbidities. Requires follow-up for adjustments. Less favored due to long-term failure risk. |
| Revision Surgery | ✅ Often covered if original bariatric procedure failed or complications are present. Requires documentation. | Previous bariatric patients with weight regain or medical complications. Surgeon must prove medical necessity. |
Surgeries not covered by medical insurance
Insurance companies typically do not cover the following procedures:
- Endoscopic Sleeve Gastroplasty (ESG)
- Mini Gastric Bypass (not widely FDA-approved)
- Post-weight loss cosmetic surgery (e.g., tummy tuck, body lift)
These are considered elective or cosmetic unless proven medically necessary due to complications like severe skin infections or functional issues.
Why Insurance Coverage Varies
Insurance coverage for bariatric surgery is not universal. Each plan has its own medical policy and eligibility requirements. Factors influencing coverage include:
- The type of plan (PPO, HMO, Medicare, Medi-Cal)
- The insurance network of your preferred surgeon and hospital
- BMI and weight-related medical conditions
- Supporting documentation such as a psychological clearance, lab tests, or medical history
- Completion of a physician-supervised weight loss program (in many cases)
How Dr. Moein Helps You Get Insurance Approval for Weight Loss Surgery
Dr. Babak Moein is one of the few surgeons in the U.S. who is dual board-certified in both bariatric and cosmetic surgery. With over 20 years of experience, he and his staff have helped hundreds of patients navigate insurance-based approval for weight loss surgery.
At Healthy Life Bariatrics, we offer:
- Free insurance verification
- Help with gathering the necessary medical records
- Assistance in submitting letters of medical necessity
- Coordination with primary care physicians and specialists
- In-office psychological and dietary evaluations when needed
We also work directly with your insurance company to streamline the authorization process—so you can focus on your health and transformation.
Bariatric Surgery Insurance in Los Angeles: Final Thoughts
If you have obesity and are considering weight loss surgery in Los Angeles, your first action is to inquire whether or not your insurance plan covers the procedure.
Our fees for services rendered are the same to the insured as they are to the non-insured. Your policy can include allowances on a fixed fee schedule. Keep in mind that insurance policies vary incredibly from one another in what they cover.
Besides, there are some insurance companies that settle claims immediately and others take months to settle.
Call our Los Angeles office for information on insurance and how it may cover bariatrics.
