In the United States, obesity has become an important public health issue. According to the Centers for Disease Control and Prevention (CDC), the prevalence of obesity is over 40% among adults and 19% among children.

Obesity not only affects an individual’s quality of life but also increases the risk of chronic diseases such as diabetes, heart disease, and certain types of cancer. For some individuals, obesity surgery may be a viable option to lose weight and improve their health. However, the cost of such surgery can be prohibitive, and health insurance coverage is not always clear.

What is obesity surgery?

Obesity surgery, also known as weight loss surgery or bariatric surgery, is a surgical procedure that helps individuals lose weight by reducing the size of the stomach or bypassing part of the digestive system.

There are different types of obesity surgery, such as gastric bypass, gastric sleeve, and gastric banding.

A gastric bypass surgery involves dividing the stomach into a smaller upper pouch and a larger lower pouch and connecting the small intestine to the upper pouch.

This makes individuals feel fuller faster and reduces the amount of food absorbed into the body. A gastric sleeve surgery involves removing a portion of the stomach, reducing its size by about 80%.

A gastric banding surgery involves placing an adjustable band around the upper part of the stomach, which limits the amount of food that can be consumed.

Who qualifies for obesity surgery?

Obesity surgery is typically recommended for individuals who have a body mass index (BMI) of 40 or higher or a BMI of 35 or higher with at least one obesity-related disease such as diabetes, high blood pressure, or sleep apnea.

However, eligibility for obesity surgery may vary depending on the individual’s health status and medical history.

How much does obesity surgery cost?

The cost of obesity surgery can vary depending on the type of surgery and the location. On average, gastric bypass surgery costs about $25,000, gastric sleeve surgery costs about $15,000, and gastric banding surgery costs about $10,000.

These costs may include pre-operative testing, surgery fees, anesthesia fees, and post-operative care. In addition, some individuals may incur additional costs such as transportation and time off work.

Does health insurance cover obesity surgery?

Health insurance coverage for obesity surgery varies depending on the individual’s insurance plan and the type of surgery. Some insurance plans may cover all or some of the costs of obesity surgery, while others may not cover any of the costs.

In 2013, the American Medical Association recognized obesity as a disease, which means that insurance companies are now more likely to cover obesity-related treatments, including surgery.

However, insurance coverage for obesity surgery may still be limited or require prior authorization.

Types of health insurance plans

There are different types of health insurance plans that may cover obesity surgery, including:.

Medicare

Medicare is a federal health insurance program that is available to individuals who are 65 years or older, have a qualifying disability, or have end-stage renal disease.

Medicare may cover obesity surgery if certain criteria are met, such as a BMI of 35 or higher and a documented history of unsuccessful diet and exercise programs. However, Medicare may not cover all types of obesity surgery, and prior authorization may be required.

Private health insurance

Private health insurance plans may offer coverage for obesity surgery, although the extent of coverage may vary depending on the plan. Some plans may cover the entire cost of the surgery, while others may only cover a portion of the cost.

Prior authorization may also be required before the surgery can be performed.

State Medicaid programs

Medicaid is a joint federal and state program that provides health coverage to individuals with limited income and resources. Each state has its own Medicaid program, and coverage for obesity surgery may vary depending on the state.

Some states may cover all or part of the cost of obesity surgery, while others may not cover any of the costs. Prior authorization may be required before the surgery can be performed.

How to get insurance coverage for obesity surgery

If you are considering obesity surgery, it is important to talk to your health insurance provider about your coverage options.

You may need to provide documentation such as medical records, proof of BMI, and evidence of unsuccessful diet and exercise programs. Prior authorization may also be required before the surgery can be performed.

In addition, some insurance plans may require that the surgery be performed by a qualified provider or in a designated facility. It is important to check with your insurance provider to find out what requirements need to be met to ensure coverage.

Conclusion

Obesity surgery can be a life-changing procedure for individuals who are struggling with severe obesity and related health issues. However, the cost of such surgery can be a barrier for many individuals, and insurance coverage may not always be clear.

It is important to talk to your health insurance provider about your coverage options and requirements for obesity surgery.