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Your health insurance paves the way for your weight-loss journey. Bariatric surgery is an elective procedure, so it is important you understand what is and is not covered by your insurance plan. Our insurance coordinator can help explain your pre-approval requirements and submit you for coverage. Most insurance plans require you to participate in a weight-loss trial under a doctor’s supervision. They may also request documents that show that your weight has been a long-term health issue.
Insurance FAQs
Will my insurance pay for weight-loss surgery?
Your coverage depends on the criteria mandated by your insurance company or employer. You may have to meet certain guidelines, such as a doctor-supervised weight-loss trial. This can last from 3 to 12 months. Our center requires you to have a minimum body mass index (BMI) of 35 with comorbidities (diabetes, hypertension, sleep apnea, etc.) or a BMI of 40 or greater with no comorbidities.
Does Medicare cover weight-loss surgery?
Medicare may cover your bariatric surgery. To qualify for coverage, you must participate in a doctor-supervised weight-loss trial for 6 months before surgery can be considered.
What does my doctor need to provide for my insurance company?
When on a supervised weight-loss trial, the following items must be documented for each visit:
- Office visit note: Must include your height, weight, BMI, and number of pounds lost or gained.
- Low-calorie diet: Documentation of a low-calorie diet with calories listed on the office visit note.
- Exercise: Record the type and duration of exercises performed.
- Behavior modification: Document your attempts to change your lifestyle to lose weight. (using stairs instead of elevators; walking instead of driving, etc).
What is a doctor-supervised weight-loss trial?
A doctor-supervised weight-loss trial is used to help document that you are unable to lose weight without surgery. The trial period can last from 3 to 12 months and requires you to visit your primary care doctor or our nutrition and weight-management specialist once a month. During the trial, your doctor will track your attempts to lose weight and your success or failure to do so.
How long will it take to get authorization from my insurance company?
The length of time it takes to process an insurance authorization is specific to each patient and their insurance’s requirements. We are committed to working with all insurance carriers to help expedite the pre-approval process.
What if my insurance will not pay or I don’t have insurance coverage?
If you do not have insurance, we do accept cash pay.
What if I still have questions?
We’re here for you. Our patient booklet, "An Introduction to Bariatric Surgery at the Sacred Heart Surgical Weight-Loss Center" was written as a resource for patients throughout the weight-loss journey. You will find information about procedures, what to expect, nutritional guidelines, potential problems and solutions on how to address them. The book is accessible to download on our homepage. For more questions, please call our office at (850) 416-7546.
