Will My Insurance Cover Bariatric Surgery?

Posted: Apr 17th 2020
Categories: Bariatrics

Weight loss is a journey — and bariatric surgery is a tool used by patients in pursuit of a healthier, oftentimes happier life. Insurance coverage is usually an essential, financial piece for our patients.

“Fortunately, in the state of New York, insurance companies are very good at providing coverage for bariatric surgery patients,” says Dr. John D. Rutkoski, a Trinity bariatric surgeon and the Director of Metabolic and Bariatric Surgery for the Catholic Health system. “That’s not the case across the country, but in New York, it is.”

Health insurance companies can provide coverage for the cost of an individual’s medical and surgical expenses. However, different insurance providers may have different requirements that need to be met before a patient can submit to have their expenses covered.

What are the insurance requirements for bariatric surgery?

Major insurance providers often have several requirements they ask bariatric patients to complete before coverage is provided for a weight loss procedure.

Trinity Bariatric Surgery has in the past, and will continue to adjust our services to better meet our patients’ needs, in addition to their insurance carriers. We have done so by making common insurance requirements part of our preoperative process.

This may include:

    • Proof your procedure is medically necessary. Often, coverage for bariatric surgery requires sign-off by the patient’s primary care doctor. This is known as a “letter of medical necessity” and is different than a presurgical clearance which takes place the week prior to your surgery. If you do not have a primary care provider, our office team may be able to recommend one.
    • Documented attempts at weight loss. Most insurance companies do recognize that people who are significantly overweight are more likely to experience serious health complications. However, it’s fairly common for insurance providers to ask patients to document their other attempts at weight loss, to demonstrate they are turning to bariatric surgery as a solution.
    • Evaluation by a mental health professional. A mental health assessment will be performed by a psychiatrist, psychologist, or licensed clinical social worker (LCSW). Psychological evaluations prior to bariatric surgery help ensure that you are mentally prepared for the lifestyle changes necessary for success following your procedure.

Our bariatric surgery team goes out of its way to support patients seeking insurance coverage for bariatric surgery. Additional support is provided by:

  • Registered dietitians
  • Physical therapists and trainers
  • Office administrators

We’ve also had to adjust to changes in insurance pathways.

Updates made by insurance carriers can affect the requirements a patient needs to meet before submitting for coverage. In this case, we have seen several insurance providers make changes to their bariatric surgery requirements at the start of the 2020 calendar year.

It has become more common for insurance companies to ask that a medically-supervised attempt be made at significant weight loss before a patient can be approved for bariatric surgery coverage. This usually consists of monthly visits with your doctor, for a length of time predetermined by insurance. It can range from 3 months to a full year.

While our office team cannot adjust your insurance requirements, our providers remain committed to our patients every step of the way. We work hard to ensure patients feel supported, empowered, and comforted in the months leading up to surgery.

Call (716) 893-0333 today to schedule your appointment.