Does Health Insurance Cover Weight Loss Surgery?
Health insurance may cover weight loss surgery, although that coverage depends on a variety of factors. Health insurance coverage is different in each state, with each insurance carrier, and within each particular plan.
You may also have to fit very specific parameters to be eligible for coverage and follow strict procedures to ensure that you remain eligible. The coverage can also depend on the type of weight loss surgery you choose and where you choose to have the procedure done.
What types of weight loss surgeries are there?
Weight loss surgery, also known as bariatric surgery, consists of a variety of procedures that help you lose weight to reduce your chances of suffering from severe medical issues linked to obesity. The Mayo Clinic says restriction and malabsorption are the two main factors produced by the surgeries that lead to weight loss.
The restriction factor works by physically restricting how much food your stomach can hold. This, in turn, limits the number of calories you can consume overall. Malabsorption works by shortening or going around a section of your small intestine, thereby decreasing the overall amount of calories your body absorbs.
While all bariatric surgeries set out to help you lose weight, they do so in different ways. Three types of bariatric surgery are common. They are roux-en-Y gastric bypass, sleeve gastrectomy and laparoscopic adjustable gastric banding.
What’s the difference among the types of surgeries?
The roux-en-Y version of the surgery restricts your food intake by creating a small pouch above your stomach where food is received. The small pouch is connected to a portion of the small intestine while the main stomach is connected to another part of the small intestine so it may continue to provide essential digestive juices to your system.
Since food is only allowed in to the small pouch and not the main stomach, your food and drink intake is drastically limited. The route the food and nutrients travel through the small intestine is also shortened, limiting the amount of calories your body absorbs.
Sleeve gastrectomy actually removes part of your stomach, leaving a smaller organ that can only hold smaller amounts of food. While your stomach’s capacity may decrease, the full amount of nutrients and calories are still absorbed into your body.
Laparoscopic adjustable gastric banding involves the use of an inflatable band to divide your stomach into two parts. The top part of your stomach receives the food, which can travel to the bottom stomach area through a very small opening. You feel full quickly as the top portion of your stomach becomes full, although all the calories and nutrients are still absorbed by the body as the food travels through the full length of the small intestine.
What factors might qualify me to be eligible for weight loss surgery coverage?
Health insurance companies may only give the nod for covering bariatric surgery if certain conditions exist, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Because the average cost of weight loss surgery typically ranges between $20,000 and $25,000, coverage may be an essential element in a final decision.
Eligible participants may have to be suffering from at least one health issue associated with obesity. The surgery may also have to be a feasible option for correcting your medical condition.
Insurance companies can also refuse to cover the surgery unless it takes place in a facility and by a surgeon that is part of their network of providers. You may also need to obtain pre-approval or certification from the insurance company before you schedule the procedure.
Does bariatric surgery work?
Weight loss surgery can be successful in helping you lose weight, but you still have to do your part for the procedure to play a part in a long-term solution to obesity. People considering the surgery should be willing to change their eating and lifestyle habits after the surgery to make the undertaking worthwhile.
They should also be aware of the changes required to adapt to the side effects of the surgery. For example, those who opt for the surgery can no longer eat large meals and they must also chew their food very well to ensure proper digestion. Their range of food choices may also become limited. High-calorie snacking and indulging in fatty, unhealthy foods can still lead to weight gain even after the procedure.
Lifestyle changes can also include incorporating regular exercise into their routine to help them achieve and maintain a healthy weight. Bariatric surgery is not a magic answer to weight loss, yet it remains a viable option in cases where less invasive weight-loss methods are not likely to produce results.
People should also be well aware of what the surgery entails and the risks associated with it. One more requirement is constant follow-ups to ensure no complications arise or problems develop with the initial surgery, such as excessive stretching of a stomach pouch or staples that come loose or fall out.