Gastric sleeve (sleeve gastrectomy) is quickly becoming an important option for many people who are considering weight loss surgery. As a result, many insurers now cover all or some of the costs associated with gastric sleeve surgery.
Insurance coverage for gastric sleeve surgery varies by state and insurance provider. As it now stands, Aetna, Cigna, Emblem Health, HealthNet, Priority Health, Health Care Service Corp, certain Blue Cross-Blue Shield programs and United Healthcare all cover gastric sleeve surgery for individuals who meet certain criteria.
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Gastric Sleeve Insurance Coverage: What Is Covered?
Almost all PPO Insurance companies recognize the necessity of the Gastric Sleeve operation for patients who have been unable to find success using other non-surgical weight loss methods. They understand that as you lose more weight, the less likely it is that you will suffer from other obesity-related conditions, such as type 2 diabetes, hypertension and obstructive sleep apnea.
Gastric sleeve insurance coverage may also even include the post-operation elements that are necessary to be successful with your procedure such as support groups, exercise and nutrition counseling.
Whether or not your coverage is denied, our trained staff of insurance professionals are experts at helping you get your gastric sleeve surgery approved. Just call our Gastric Sleeve Insurance Hotline at 1-855-690-0559 or fill out our FREE Gastric Sleeve Insurance Verification Form!
Gastric Sleeve Insurance Coverage: Criteria Varies by Insurer
Insurance carriers cover the cost of gastric sleeve surgery if you meet certain pre-specified criteria, which vary by company. Most insurance companies/employers that offer gastric sleeve surgery insurance coverage require a body mass index (BMI) equal to or greater than 40for gastric sleeve surgery, or a BMI of 35 if there are significant medical problems associated with your weight, like Type 2 diabetes, hypertension, sleep apnea and heart disease. A BMI of 40 or above is the equivalent of being about 100 pounds overweight for men and 80 pounds overweight for women.
Disparities in gastric sleeve insurance coverage are common. United Healthcare will cover the cost of gastric sleeve surgery for individuals with a BMI of 40 or higher, or a BMI 35 to 39.9 and one obesity-related illness. Other insurers have significantly higher BMI requirements because they have not updated their requirements to include the gastric sleeve as a standalone, primary bariatric surgery procedure. For example, Blue Cross-Blue Shield Arkansas requires a BMI of 60 or higher for gastric sleeve surgery coverage. If a person has severe heart and lung problems associated with obesity, however, they may lower the BMI requirement and cover the costs of gastric sleeve surgery.
Gastric Sleeve Insurance Coverage: Action Points
Many private insurers will require a "letter of medical necessity" from a surgeon before they agree to pay for your gastric sleeve surgery. The letter should include information on your height, weight history and BMI, a detailed description of your obesity-related health conditions, your current medications and a detailed description of how obesity affects your daily activities.
Be proactive where you can. Start collecting letters and documentation from all health care professionals who have treated you for obesity-related problems now. Keep detailed records of all your weight loss attempts.
Gastric Sleeve Insurance Coverage: Other Options
If you choose to pay cash for gastric sleeve surgery, complications may not be covered. Some bariatric surgery centers may offer “reinsurance” plans that will cover the cost of complications during the first year after surgery if you pay cash for your gastric sleeve surgery.
You have options, and discovering them is just a phone call away. Call our Gastric Sleeve Insurance Experts Hotline at 1-855-690-0559 or fill out our FREE No Obligation Gastric Sleeve Insurance Verification Form.