Insurance for Weight Loss Surgery

The dramatic increase in the amount of bariatric surgeries performed recently as a treatment for severe obesity has become the focus of private insurers in the United States in the last few years, and more insurers are now offering insurance for weight loss surgery.

Weight loss surgery can be very expensive depending on the procedure performed. Even though most patients will only stay a few days to recover in a hospital, some of the procedures require specialized equipment, advanced surgical and nursing training, experienced surgeons, and many other things, all of which can increase the overall cost of the treatment.

Bariatric procedures can range from $4,000 to upwards of $25,000, so many people are looking at insurance for weight loss surgery to cover the costs.

Click here to read more about Insurance For Gastric Sleeve Surgery.

Unlike Medicare, many private health insurers are now focusing on a short term timeline. This focus on short term is because the insurance companies are in business, not for charity, but for the money, and they must report to stockholders every 3 months. Another factor is that the average American stays with any one insurer for less than three years before changing to another insurance company, which is not good news for the insurer should that person use the insurance for weight loss surgery. The cost savings of any bariatric treatment might not be realized in such a short time frame.

Why Is It Hard To Get Insurance For Weight Loss Surgery?

Think of this like this:
You need bariatric surgery, and you pay an insurance company let’s say $500 a month for health coverage. The average person will stay with an insurance company for 3 years, that’s 36 months, so…36 months * $500/month = $18,000 for 36 months.

So that’s $18,000 you will pay for 3 years of health coverage, and remember, insurance companies see that most people switch insurers every 3 years, so if you use insurance for weight loss surgery, the insurance company generally has 3 years to get that money back.

Now, let’s say you undergo a bariatric surgery that costs $20,000, you use your insurance for weight loss surgery so the insurance company pays for it since you qualify based on the coverage guidelines currently in place. You get the surgery, but the insurer is stuck paying an extra $2,000 if you switch insurance companies. The insurance company loses money, and businesses are not supposed to lose money. Then consider that many people do not pay $500 per month, but much less than that, which only increases the loss for the insurance company.  This is one of the major reasons why it can be a challenge to get insurance for weight loss surgery.

Insurance companies figure the chances are very high for them to lose money if they allow you use your insurance for weight loss surgery, and cover the cost for your bariatric surgery. With the number of weight loss surgeries rising, they can stand to lose a substantial amount. It is therefore prudent to them to tighten up the rules for individuals to qualify to use insurance for weight loss surgery.

Insurance for Weight Loss Surgery – Qualifying

insurance for weight loss surgery Insurance for Weight Loss SurgeryWith the rising costs that are associated with bariatric surgery, many insurance companies have had to change the rules to minimize their losses when it comes to providing insurance for weight loss surgery. Since introduced in 1991, insurance companies followed the guidelines prescribed by the National Institutes of Health Consensus Development Panel, and regarded these guidelines as the qualifications for individuals who wanted to use their insurance for weight loss surgery.

With the recent increase in the amount of bariatric procedures, many insurance companies have added “qualifiers” to those NIH guidelines. These qualifiers are things like 12 months of continuous medically supervised diet. Most people that need weight loss surgery probably have tried for years to lose weight through dieting and exercise, but it is extremely rare that these attempts have any written documentation, and even if they are, it must be documented by some type of medical professional, such as a nurse, a physical therapist or a doctor.

The bottom line here: if you want to use insurance for weight loss surgery, you must provide documentation that you have tried other means to lose weight. AND, you must show that you have tried to lose weight for at least 6 months to 12 months straight. AND that documentation must be done by a medical professional. Only then can you qualify for insurance for weight loss surgery.

Insurance for Weight Loss Surgery – The Future

The future of insurance for weight loss surgery may mean insurers will loosen up on those ‘qualifications’, but it is more likely that they will simply add ‘riders’. Riders are additional things you can add to your health insurance. You may have a general health insurance policy, and you can add a dental rider, which will allow you some type of dental coverage for example.

Of course, riders will mean your insurance premium will increase, and given the high cost of bariatric surgery, that rider will increase the monthly premium substantially, which basically passes the bulk of the cost on to you. This approach, unfortunately, also means the option to add insurance for weight loss surgery coverage will be the choice of your employer if you only have health coverage through your employer…and individual employees will likely have little to no say in that matter.

The significantly high cost for bariatric surgery also factors in to the insurance for weight loss surgery issue. Because of the complexity of getting insurance coverage for people who need a bariatric surgery, most practices will have at least one employee working full time who is responsible for screening individuals and certifying that the potential patients does qualify for insurance for weight loss surgery.