Gastric Sleeve & Insurance Coverage: What Should You Know

Gastric sleeve & insurance coverage as a combination pair is not too common in the medical field. As a weight loss surgery, the gastric sleeve is becoming a popular choice with people looking to shed some extra weight. There are insurers who cover at least a portion of the procedure.

A good grasp of the relationship between the innovative weight loss procedure referred to as the gastric sleeve and the health insurance system is vital when a patient considers this procedure. Restrictions differ widely and the same company may offer different payment options on the basis of the particular coverage the patient carries. A few basic facts about the gastric sleeve and insurance considerations that may affect payment can help individuals make an informed decision.

How Much Will Insurance Cover?

  • The amount of the coverage will vary depending on the state the patient lives and the insurance company he or she has chosen for. The companies who provide insurance coverage for gastric sleeve to individuals meeting the necessary criteria are Medicaid, Aetna, Emblem Health, Cigna, Health Net, Priority Health, United Healthcare and Health Care Service Corp.
  • Some of the state-run Medicaid programs provide coverage for this surgery. At current, no Medicare program covers this surgery, although there is a possibility that in near future, they too will include gastric sleeve under coverage. At present, the gastric sleeve coverage includes the surgeon’s fee, anesthesia fee and the hospital facility fee. Full bill may be covered by a few insurers, but the most insurers generally cover 80% of the total cost. Some insurers may also require a co-pay.

What about Post Operation Help

Patients about to undergo a gastric sleeve surgery or are considering one, must contact their insurers first to know what will be paid. He must also enquire whether the company will cover the follow-up procedures- those that are performed after the completion of the surgery for cosmetic corrections. These procedures include corset trunkplasty, duodenal switch, bra line back lift, and others.

Some Things to Consider

Insurance companies may have certain unique stipulations for patients to be eligible for this coverage. For example, those with a BMI of 40 or greater are generally considered eligible for this coverage. In case of certain medical conditions like sleep apnea, type 2 diabetes, and heart disease, patients with a BMI of 35 are approved. These stipulations are not very consistent.

The gastric sleeve & insurance coverage constitutes a somewhat uncertain and vague area of insurance eligibility. With accompanying health issues, the BMI requirements generally go higher. For example, Blue Cross-Blue Shield Program of Arkansas lists a BMI requirement of at least 60 to be eligible for this coverage. Therefore, a patient undergoing a gastric sleeve surgery should consult with his insurer prior to the surgery and should ask for detailed information regarding the nature of the coverage.

Individuals should do careful research on both the actual gastric sleeve and insurance requirements that pertain to their particular policy before opting for the procedure. Another wise choice is counseling from an experienced medical specialist. Getting a grasp of the facts can lower the likelihood of emotional hardship and unpleasant surprises at a later date.

Post new comment

The content of this field is kept private and will not be shown publicly.

Disclosure: We review and test many products on this site. Nobody pays us to review their product. However, if you end up purchasing one of these products we sometimes receive a small fee from the merchant. This helps to keep the site maintained and running.

User login

Theme provided by Danang Probo Sayekti on Hostgator