Bariatric Surgery Insurance Coverage: Questions You Should Ask, Things You Should Know

For some individuals, going through bariatric surgery is an easy decision. However, finding a way to finance it is a different story.  You need to work with an insurance company and that may be challenging. What are the available financing options?

Karen works for a bariatric surgeon and gives helpful information to consider and specific ways to get financing that some may have a hard time finding. Here is what Karen advises:

“As you think about having bariatric surgery, most patients are having some financial considerations and you hope that the insurance company that you have right now will cover the operation. If you’re making your first inquiry we usually tell our patients to first of all, just be very specific about asking which procedure you’re interested in and then asking if there are any exclusions for that procedure. Sometimes insurance companies will just say “no we don’t cover bariatric surgery” but what they don’t tell you is they will  "if its is  medically necessary”. So you want to make sure that you ask about exclusions and ask, “well would it be covered if it’s medically necessary?” Most bariatric surgery programs will also make that call for you and they are very experienced at knowing what questions to ask in that regard.”

“Patients that find out that bariatric surgery is excluded from their policy, we have a couple strategies for that. I think that the first thing you can do is try to educate your employer. First giving them articles or information. Bariatric surgery programs can usually help you by providing you information about how bariatric surgery saves employers money in the long term. Especially smaller companies will sometimes make an exception and cover one employee based on their health and their cost to the company which will be much less after the bariatric surgery.”

“If those efforts are unsuccessful in obtaining coverage, then the only other option is finding a way to finance the operation. Some people go to a bank and finance at their own institution. Other programs actually have payment plans available right there at their facility. I think the message here for patients is that most people will tell you that it’s the best money they ever spent; that although there is that upfront expense to their lives, that what they gain back in return is so much more as far as their increased health and just feeling better each and everyday.”

Financing weight loss surgery may be a burden for an individual who needs to pay the fee themselves or for employers or insurance companies. However, the initial cost pays off in the end and will end up saving everyone involved money in the end. Looking for financing will be a much easier process if the future patient is educated with the surgery itself and the terms of their insurance company or employer.