Criteria for Bariatric Surgery Coverage by Insurance Company:

Insurance companies are frequently changing their coverage criteria and have multiple medical plans. Please call directly to your Insurer's Members Service and confirm current requirements and eligibility for bariatric surgery coverage in your particular case.

Most frequently encountered requirements by Insurance company:

AETNA: NIH criteria, 5 y documented by a doctor history of obesity, consecutive 6 mo (or to 3 mo periods) supervised diet within 2 past years, evaluation by dietician & psychologist.

Blue Cross/Blue Shield: NIH criteria,  supervised 6 mo (or 3 mo x2) diet within 2 past years, evaluation by dietician & psychologist.

Blue Cross Federal: NIH criteria, evaluation by dietician & psychologist.

CIGNA: NIH criteria, supervised  6 mo diet within 2 past years, evaluation by dietician & psychologist.

MAMSI/MDIPA/Optimum Choice: NIH criteria, evaluation by dietician & psychologist.

MAMSI/MDIPA/Optimum Choice Federal: NIH criteria, supervised 6 mo (or 3 mo x2) within past 2 years, evaluation by dietician and psychologist.

MEDICARE: NIH criteria, supervised 6 mo diet, evaluation by dietician & psychologist, participation in preparation/conditioning program with surgeon for 3 mo, co-morbid conditions include only hypertension untreatble with 2 or more medication, diabetes Type II, sleep apnea, severe arthritis requiring joint replacement, fatty liver; Weight loss of 10% and more before surgery makes patient ineligible for surgery; revisional procedures are not covered unless there is a complication of initial surgery.

UnitedHealthcare: NIH criteria, 5 y documented by a doctor history of obesity, evaluation by dietician & psychologist.

 

 Can I Self-Pay for my Weight Loss Surgery?

Our preference is for you to use your insurance to avoid the significant (up to 90% of total charges)hospital and other related costs. At present, overall cost of Lap Band surgery is about $15,000, gastric bypass surgery - $20,000 and vertical sleeve gastrectomy  -  $ 17-18,000. Most insurance companies do authorize bariatric surgery and we are prepared to work with you to obtain authorization and help you with appeal process if needed.

Unfortunately, there are multiple exclusion in various insurance plans, restrictive covenants and conditions. Some medical insurance plans, especially small businesses and etc., completely exclude coverage for weight loss surgery.

If you need to self-pay, please contact our office and insurance specialist will advise you on available financing options which work similar to car loans financing and cover total costs of surgery.