What insurances cover bariatric surgery?

The major medical insurance providers that offer bariatric surgery coverage are Aetna, Blue Care Network, Blue Cross/Blue Shield, CHAMPVA, Cigna, Cofinity, Medicare/Medicaid, OptumHealth, Physicians Care Health Plans, Priority Health, Tricare and United Healthcare

Insurance providers only pay for bariatric procedures performed at recognized weight loss surgery centers, by recognized bariatric surgeons. Even if your insurance plan does cover bariatric surgery, an approval of the treatment might be legally needed. Contact us for insurance information and help to go through the approval process.

After an initial contact with our office, several steps will be followed:

  • The insurance specialist at the weight loss center will ask for information to check if your insurance plan offers coverage for the bariatric procedure of your choice.
  • The consultation with the bariatric team is meant to assess your health condition and confirm your candidacy for weight loss surgery.
  • Some insurance companies require a referral from your primary care medical specialist. To make sure this process goes smoothly, the weight loss center will initiate contact and will work together with your physician.
  • Confirmation of the insurance coverage and selection of the treatment plan, surgery clearance.

The exact data collected for the approval process is a dependent of your insurance plan and medical history. The letter of medical necessity usually includes: BMI, height, weight history, details on obesity-related health conditions with treatment records, details on how obesity limits the life of the patient, a history of dieting and exercise efforts, etc. Often a nutritional consult and a psychological evaluation are also needed.

Medical insurances providers that offer bariatric surgery coverage include: Blue Cross of California HMO, Axminster Med group, MediCare, MediCal, Medi/Medi (includes people who qualify for both MediCare and MediCal), UABT or blue cross of California, Blue Cross PPO, etc. Consult with insurance specialist of our weight loss center to check the terms of your insurance policy.

Anthem Blue Cross of California HMO

Anthem Blue Cross is the trade name of Blue Cross of California; an independent member of the Blue Cross Blue Shield Association, a federation of 39 separate health insurance organizations in the U.S. Anthem Blue Cross is a Health Maintenance Organization. Since December 2012 Anthem Blue Cross covers a wide range of bariatric surgeries including gastric bypass and gastric restrictive procedures from Roux-en-Y to lap band and sleeve gastrectomy for individuals at least 18 years old who meet a series of criteria. Contact your insurance provider to find out if you qualify for a bariatric procedure.

UABT or Blue Cross of California

Patients with Blue Cross of California insurance can have their bariatric surgery covered in certain circumstances. Patients with a PPO plan can have their surgery covered only if it is authorized by a preferred provider who can verify that the procedure is medically necessary to control obesity. Hospital stays at medical facilities that are not on the Blue Shield preferred list are limited to a maximum coverage of $250 per day.

Blue Cross PPO

Blue Cross Blue Shield POP plans offer a more flexible health plan with a greater choice in doctors and hospitals. Bariatric surgery is covered as long as all the "medically necessary" requirements are met. Patients can choose between gastric bypass and gastric restrictive procedures. For more information about insurance coverage and the approval process please contact our insurance information.

Axminster Med Group

Axminster Med Group is a member of Anthem Blue Cross that provides a variety of individual and family HMO insurance plans. As Anthem Blue Cross it also covers bariatric procedures for adults with a body mass index of at least 35, with one or more co-morbidity conditions, with previous unsuccessful weight loss attempts, with a history of at least two years of obesity who can present a surgeon’s recommendation letter regarding the necessity of the procedure and who passed a psychological evaluation.

MediCare

Medicare is a federal social insurance program that provides health insurance to people over the age of 65, individuals who become totally and permanently disabled, to patients with end-stage renal disease and to people with ALS. MediCare covers bariatric surgery if the following conditions are met: a BMI of at least 35 with one or more co-morbid condition, minimum two-year history of morbid obesity, 6 month PCP diet or 3 month multi-disciplinary diet, exercise and behavior modification program and psychological evaluation.

Medi-Cal

Medi-Cal is the Medicaid program in California, a public health insurance program that provides health coverage to people with low-income and asset levels who meet certain eligibility requirements. Since February 2009 the insurance plan covers bariatric surgery for individuals with a BMI of at least 35 as long as the procedure is performed at a medical facility approved by the Centers for Medicare & Medicaid Services. CMS covers gastric bypass, gastric banding and biliopancreatic diversion with duodenal switch.

Medi/Medi

Medi/Medi is a term that refers to patients covered by one of the major public health insurance plans: the Medicare for the elderly and the Medicaid for individuals with low income. In some cases, an individual can be covered by both insurance plans. Whatever the case since both plans cover bariatric surgery, patients can benefit from certain surgical weight loss procedure if they meet the necessary criteria. 

Disclaimer: We do not assume responsibility for the use of the provided information or its interpretation. Our efforts are towards providing current and reliable information; however these should not be considered, or used as a substitute for diagnosis or treatment.

Source: https://www.cedars-sinai.edu/Education/Medical-Library/

Meet Our Physicians