Will Insurance Cover My Weight Loss Surgery?

By Daniel McCullough, MD

By the time a patient meets me for their first consultation, they are typically pretty eager to begin their weight loss journey. While many people associate bariatric surgery with rapid weight loss, the overall process does take months. One of the most common questions patients have when they first meet with me is why the process takes so long.

The answer is actually more complicated than people think at first, but ultimately, patients understand its importance in maximizing their chance for success. Over the next few months, I’ll be writing a series of columns to explore why patients need to be prepared properly for surgery in order to maximize the chance that their weight loss journey is successful.

So, why does the weight loss journey take so long? The first part of the answer is brought to you courtesy of your insurance company.

Meeting Your Insurance’s Criteria

One of the first steps we take at ProMedica Weight Loss Surgery, once you’ve expressed interest in our program, is to check with your insurance company to see if you have a benefit for weight loss surgery. We also check to see what requirements need to be met before the insurance company will approve the operation. You can also check with your health insurance company directly through the customer support number (on the back of your insurance card) to learn more about your benefit coverage.

Most insurance plans mandate that patients spend anywhere from 3-6 months undergoing medically-supervised weight loss before they will be approved for surgery. The rationale the insurance companies use is that they want to ensure the patients are dedicated to losing weight before the insurance company assumes the significant cost of weight loss surgery. This wait helps protect the insurance company from patients that are more likely to fail surgery and regain weight. Insurance companies do not like to spend money unless they have reasonable assurance that the money will be well-spent.

In addition to 3-6 months of medically-supervised weight loss, many insurance companies now want patients to lose weight before approving the operation. This may be anywhere from 3-5% of total body weight. We track patient weight at each nutrition visit, so that this weight loss can be documented appropriately.

Your insurance company may also want you to undergo medical evaluation by a cardiologist (to check your heart), a pulmonologist (to check for breathing problems), or sometimes just a medical clearance from your primary care provider.

In short, your insurance carrier may offer benefit for bariatric surgery but even if they do, there are regulations that must be followed to ensure coverage. Of course, all of these steps take some time to complete.

In next month’s column, I’ll discuss how we prepare patients nutritionally for their upcoming operation. Eating right, as I like to say, is a critical aspect of successful weight loss.

Have general questions about bariatric surgery? Let me know in the comments below or take an online seminar on ProMedica’s website.

Daniel McCullough, MD, has been a bariatric surgeon for the past 10 years. Prior to joining ProMedica Physicians in July 2016, Dr. McCullough practiced in Maryland, Delaware and Virginia. He completed a Bariatric Surgery fellowship at The University of Virginia, residency in General Surgery at The University of Toledo Medical Center, and medical school at the Medical College of Ohio (UTCOM). He is a native of Toledo, Ohio.





For more information, visit ProMedica HealthConnect

Tags: Bariatric Surgery, daniel mccullough, insurance, surgery, weight loss surgery, weight management, wellness