Insurance & Gastric Bypass

All major insurance companies offer the option to cover gastric bypass surgery in cases of medical necessity, including Blue Cross Blue Shield, Cigna, Kaiser and Aetna. However, not every plan offered by those companies covers the surgery.

Exclusions

• While all major insurance companies cover gastric bypass surgery in cases of medical necessity, some employers opt to exclude weight loss surgery from their plans. This saves money on premiums. Check with insurance company to determine if your plan covers weight loss surgery.

Medicare and Medicaid

• Medicare and Medicaid both cover gastric bypass surgery in cases of medical necessity. Medicare requires patients have surgery at a Bariatric Surgery Center of Excellence.

Medical Necessity

• Most insurance companies consider gastric bypass medically necessary if patients have a Body Mass Index (BMI) of 40 or above, or if they have a BMI of 35 or above and weight-related health problems such as diabetes or sleep apnea.

Requirements

• Most insurance companies require patients to have a history of failed weight loss attempts before they will pay for gastric bypass surgery. Most require patients to undergo a psychological evaluation and nutritional counseling prior to surgery.

Cost

• Most insurance companies do not cover the full cost of gastric bypass surgery. Patients usually have co-pays they must pay out-of-pocket. Check with your insurance company to find out how much you must pay.