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First things first I am NOT a doctor or an insurance specialist. I can only tell you what I know from my own personal experience. My insurance covers bariatric procedures as long as you meet certain guidelines and I will talk about those below so the FIRST thing you should do when seriously considering any bariatric/weight loss procedure is to check with your insurance provider to see what type of coverage they offer.
I recently opened up my IG stories for questions regarding my weight loss surgery and one of the main things I got asked was “how much did your surgery cost?” The second top question was “did insurance cover any part of your surgery?” Obviously I answered above that my insurance did cover my surgery but there were many, many hoops I had to jump through in order to make that happen.
The first thing I did was make sure my insurance covered bariatric surgery. The website said they did but I called to talk to someone to verify that the coverage was still in place and it was.
The second thing I did was look to see what you had to do to qualify for surgery and my insurance had a few rules. First you had to have a BMI of 35-39 with at least one co-morbidity (high blood pressure, sleep apnea, diabetes, etc) or you had to have a BMI of 40 and above with zero co-morbidities.
The next step to qualify was to have documented proof of some sort of 6 month weight loss program within the last 12 months with ZERO weight gain during that time. Most people just do this through a program set up with their bariatric surgeon.
And lastly my insurance requires you have to complete a psychological evaluation to see if you are ready for surgery and understand all of the lifestyle changes that go along with it.
After verifying all of this information I looked to see which surgeons were covered under my insurance and contacted the group that was covered. I heard back from the program coordinator and set up my first appointment with a surgeon in that group.
At my first appointment my surgeon made sure I qualified BMI and co-morbidity wise (I had a 35 BMI and high blood pressure), explained all of my insurance requirements and then had a few of her own.
My surgeon’s requirements, in addition to the requirements my insurance wanted, included clearance by a cardiologist, at least two support group meetings, and a sleep study (and compliance with a CPAP/BIPAP if needed).
I met monthly with my surgeon and her team for six months and slowly checked things off my list while losing/maintaining/NOT gaining any weight and when it came time for her to submit everything to my insurance I was a nervous wreck!! I followed all of their instructions and met all of the requirements so I have no idea why I stressed so much about it but I did.
Insurance has two weeks to approve or deny and of course mine took the whole two weeks but I finally got an email from my surgeon and a letter in the mail saying I was approved for surgery!!!
In an ideal world I would have immediately started my 2 week liquid diet and then had surgery the month after that but then COVID hit and I had to wait three more months for my surgery but I can honestly tell you that it was well worth the wait.
So long story short, if your insurance has bariatric surgery coverage make sure you meet all of their requirements and you should be good to go!
If you have any questions about anything please drop a comment or email me!!! firstname.lastname@example.org You can also check out my last weight loss surgery post (about why I did it) here!