Gastric Bypass Surgery - Will Insurance Cover the Cost?
Posted: Wednesday, November 09, 2005
by Craig Big-T Thompson
http://www.renewedreflections.com
Depending on the type of major medical insurance policy you have, most insurance companies will pay for gastric bypass surgery (also called bariatric surgery) if you meet certain conditions. However, some insurance companies have exclusion clauses for treating obesity. These companies refuse to cover any treatment related to "losing weight." They will, however, treat the diseases caused by excessive body weight.
To qualify for coverage, gastric bypass surgery must be considered a medical necessity. The insurance company will make the final determination. They may rely on the information your doctor sends to them or they may require you to be seen by a doctor that they specify.
In either case, certain conditions must exist. Your weight problem must present a serious risk to your life. Don't be surprised if they require a complete psychological evaluation in addition to your medical records. It is no secret that people eat too much of the wrong kinds of food for many reasons. While genetics and metabolic rate do affect how much a person weighs, often the primary causes of obesity are emotional and psychological. Gastric bypass surgery will not fix these emotional and psychological problems. In fact, if these issues are not dealt with prior to or along with the surgery, the patient may be more likely to experience serious complications. For this reason, all insurance companies require both a medical and psychological clearance before they will approve the surgery.
Remember, insurance companies are businesses. If they think you are a good candidate to maintain the weight loss permanently and that the $25,000 to $50,000 dollar price tag for gastric bypass surgery now will save them money in the long run by eliminating payment for other weight related medical problems, they will most likely cover the surgery.
How much will my insurance carrier cover?
If you are approved for gastric bypass surgery, your insurance company will pay anywhere from 50 to 100 percent of the hospital and doctor fees. Some policies will even cover in-home nursing care after release from the hospital if it is deemed necessary by the doctors and approved by the insurance company.
Several different expenses typically are associated with gastric bypass surgery, such as testing to determine eligibility for gastric bypass surgery, pre-admission testing, in-hospital costs, surgeon and other doctor fees, and post-surgery medication and care. Even if your insurance company will not cover the actual procedure, they may cover one or more of the other costs related to your gastric bypass surgery.
How can I make up the difference?
Your surgical center should be able to help you determine what will and will not be covered by your specific policy. In addition, many surgical centers offer low-interest, long-term loans if you are not approved by the insurance company, do not have medical insurance, or have high co-payments.
Since 2000, the total cost of all medically necessary weight loss treatment has been considered a deductible medical expense for income tax purposes. Those tax deductions can help you pay for at least part of the cost of your gastric bypass surgery or help you get back your co-payment for the surgery. Under the Internal Revenue code, treatment for weight loss includes behavioral counseling, nutritional counseling, prescriptions, and gastric bypass surgery if they are undertaken to treat or prevent specific diseases caused by excessive body weight.
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This article provides an overview of health issues related to gastric bypass surgery and is not intended to replace the advice of a medical practitioner. Please consult your doctor prior to making any major medical decisions.
This Article has been viewed 35,937 times. (Not updated in real-time.)
More commentsMelissa - What a Crock! I hope that one of your loved ones never has to go through weight loss problems, maybe that would change your opinion...btw, I don't especially like paying for your kids runny nose either.... and one more thing, if you want obese people to take better care of themselves and lose weight on their own because their obesity problem isn't your problem, then you need to take a long look in the mirror. I didn't get you pregnant, and you have a choice whether or not to have kids (Birth control can be obtained free everyday of the week if you can't afford it) - you made the choice to have children, and my tax dollars took care of their medical needs. Sounds like a classic case of pot calling kettle black
I just want to know if any medicaid or Insurance in Arkansas covers this surgery? I saw a lot about Tennessee, Kentucky, and Ohio but not Arkansas, anyone?
You probably need to speak with your insurance company in detail, but many of them will probably deny your claim unless you can prove to them that you've tried everything else (diet, exercise, etc.) and failed before they pay for surgery.
I just need to add my two cents about all the hype on whether or not the government insurance should cover this type of surgery or not. Im usually not one to call out a person, but some people are not seeing beyond their nose on this issue. The morbidly obese, disabled americans, whom have paid into "our" tax system are entitled to use it. If they are ill, they need to get well. If they keep becoming ill, BECAUSE of being morbidly obese, dont you think its costing MORE???? Its less expensive in the long run to provide preventative maintenance, just as a Dr would perform a double or triple heart bypass. Try to think beyond. Your not the only one putting money into the tax system, and us americans are not the only ones to spend it either. Ease up!!
Does anyone know about any insurance in Washington state that covers this at all? or what companies might have said insurance? i've been without insurance almost my entire life so being able to prove this is a problem for me is difficult.
Does anyone know if Florida Medicaid pays for gastric bypass surgery?staywell does again as of march 9th 2009
Wisconsin Medicaid does pay for these procedures you must be under a doctor suprvised diet for 3 months . I am going through the surgery soon. Gl to everyone. And to the people that think this should not be a covered issue... It costs more to care for people that are Obese with other health issues in the long run. And many people have payed taxes!!! Get over yourselves. Some people are obese because of hereditary genes. Some people were in accidents and are not as mobile as they used to be. Surgery has improved peoples chances on returning to work...Hi Melissa my name is Yvonne and I'm thinking about getting the surgery!I would love to ask you questions because I'm on wisconsin Medicaid too and new too this can you please email me so we can talk Thank you vonn.coleman@yahoo.com
I am from NY and I too am considering the GB, however I dont know if medicaid will pay for it here. Can anyone tell me if it does please. And before anyone starts up on me about medicaid, I worked since I was 14 years old, I am a college graduate, I was injured at my job which made me unable to be as active as I use to be. I can not stand no longer then one hour or sit more then 30 minutes. Most of my time during my injury I spent it in bed which cased me to gain lots of weight. As I got back on my feet the weight was a big problem and prevented me to be without pain on my back and knees which are the areas that I was injured. Now I can not even shed these pounds off. I tried exercise, dieting, pills, anything that sound hopeful and I was unsuccessful. So right now I am in desperate state and I need to loose this weight so I could have my life back and go to work since I am only 42 years old. Please if anyone knows if it covers in the New York area let me know. Thank you all.
i found out that ALABAMA medicaid wont pay for gastric bypass thru bariatric doctors! i did however discover that there are tons of GASTRO doctors that accept alabama medicaid! i spent almost 2 weeks trying to find a doctor that medicaid will pay and came up empty until i called medicaid and asked the rep for a list of doctors that will accept alabama medicaid because i am a recipient for the surgery....she instructed me that there was and that i was having a hard time because i was calling the wrong type of doctors! so instead of contacting weight loss centers and bariatric docs, look for gastroencrinology doctors! hope this helps!
I really wonder why if you do not have weight issues why your commenting on this website to begin with? some people have medical issues for why they have this surgery that actually have nothing to do with weight... this surgery where for people that had severe gastric problems in the beginning and no matter the reason someone has this surgery if it is going to keep them from dying then I say its better... people need to quit being so critical if you don't know because there are a lot of over weight people who didn't have an over eating problem that got heavy because they didn't were paralyzed ect in a wheel chair and maybe just maybe was unable to have a job during this down economy and all of a sudden it came down to dying or the surgery! so why don't you know what your talking about before assuming everyone is out to screw you and your tax check over. This economy is down and people who paid into the system for years with high paying jobs are on medicare these days and how dare you judge them for getting help when and where they need it..there will always be people who cheat the system as the system is made for people to fail.. not to give you a hand up till you can get up... its made to help you fail...but hopefully for those of you judging you will never have to learn of this as I hope my family and I never ever have to learn it...My god bless all of you who need it most to get what your needing in life. As for the rest of you who are so judgmental shame on you... you have no idea what got them there and I say this knowing my husband makes six figures today but tomorrow his job could put us in the poor house if he lost his job. because of mine and my daughters health issues not due to obesity it has taken all of our savings and drained it so if he lost his job we would be in bankruptcy in minutes!
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