Insurance companies may cover bariatric surgery when patients meet specific criteria, including a body mass index (BMI) of 40. Insurance may also cover surgery for patients with a BMI of 35 or greater if the patient has two or more comorbidities, such as sleep apnea, hypertension, diabetes, or heart disease.
Patients should contact their insurance provider for policy information on coverage, exclusions, deductibles, co-pays and out-of-network benefits prior to scheduling surgery.
Our weight-loss team is here to assist patients with the approval or pre-authorization process. Previous weight-loss attempts, physical condition, related illnesses, disabilities and their future impact are taken into consideration to determine medical necessity of the procedure.
Insurance Documentation Requirements
The referring physician is an integral part of the surgery approval process and may be required to document a patient's non-surgical weight-loss attempts. Documentation requirements vary by insurance coverage. Generally, documentation consists of the following patient information tracked on a monthly basis:
Supervised weight-loss program
Letter of medical necessity from the patient’s primary care doctor
The documentation period can range from three to six months.