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Insurance Qualification for Bariatric Surgery

The policies for covering bariatric surgery vary between states and insurance companies. Contact your insurance company to find out what is required of you to receive coverage.

  1. Body Mass Index

    • To qualify for insurance coverage, you will need to show that your body mass index is above a certain level, or that you have other obesity-related health problems. For most types of bariatric surgery, you will need to have a BMI of 40 or higher, or a BMI of 35 or higher with existing co-morbidities.

    Medical History

    • Your insurance company may require three or more years' worth of documentation showing a history of obesity and obesity-related health problems. Be sure to keep records from all doctors you visit for conditions related to obesity.

    Psychological Evaluation

    • Many insurance companies require psychological evaluations to confirm that the patient has no untreated psychological issues and is capable of handing the stress caused by bariatric surgery.

    Diet

    • To qualify for insurance coverage, you may need to go on a diet for a period of three to six months prior to surgery. You may also need to show proof that you have been unable to lose weight through diet and exercise alone.

    Cause of Obesity

    • To qualify for insurance coverage, you may need to provide evidence that there is no treatable medical cause of your obesity.

    Considerations

    • Even if your insurance company pays for bariatric surgery, it may not cover other related expenses such as therapy, fitness programs and nutritional supplements.

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