Insurance Cover For Gastric Bypass Surgery

An increasing number of people today find that their weight has achieved such a level that they either choose, or are more or less forced to choose, gastric bypass surgery as the only solution to their weight problem. However, having decided to undergo surgery, they are faced with the complex problem of just how to pay for the operation.

Gastric bypass surgery, including comparatively minor procedures such as gastric banding, is an expensive business requiring a highly paid surgical team, together with a stay in hospital and you are unlikely to come away with a bill of under $20,000 and could well be looking at closer to $30,000 or $35,000. Indeed, if complications arise, either immediately after surgery or during recovery at home, the final bill may rise considerably higher.

The first port of call for many people is their insurance provider. But will your insurance company meet the cost?

The answer depends in the first instance upon the form of insurance policy that you have and you will need to read through the terms of the policy with care to see whether surgery of this nature is specifically excluded and, if so, whether there are exceptions to any general exclusion. If your medical insurance is being provided by your employer then you will need to seek advice from your employer, as various insurance providers allow employers to specifically exclude weight loss surgery from their group policies.

This said, morbid obesity is a recognized medical condition and, more importantly, if left untreated it can become life threatening. Accordingly many insurance providers will cover the cost of gastric bypass surgery provided they are satisfied that surgery is a medical necessity.

So, if your insurance policy does not specifically exclude weight loss surgery and your insurance company says that your policy does not cover you when you first ask, don't merely assume that their word is gospel. Go back to them again, preferably in writing, and make your case.

Every insurance company has its own way of doing things but, in general, you will need to satisfy your insurer that this is indeed a medical necessity in your particular case, that this is the only route open to you to solve your problem and that you understand and are able to cope with the marked lifestyle changes that result from gastric bypass surgery.

This means you will typically need to provide your insurer with:

1. A full medical history provided by your doctor giving his opinion that weight loss surgery is necessary. It will also help if this is backed up by the opinion of a specialist in the field of gastric bypass surgery.

2. Proof that you have attempted weight loss under medical supervision and without success in the period before your application. This period will vary between insurers but is commonly anywhere from 6 months to 2 years. You should note that this must be a weight loss program under the supervision of a physician and that programs such as those from Weight Watchers will not generally be accepted.

3. A psychological report indicating that you understand what is involved in weight loss surgery, including the considerable changes that it will make to your lifestyle, and that you are considered able to cope with the stress that this will involve.

Once you are able to meet these criteria, your insurance provider will generally be happy to meet the costs of gastric bypass surgery.

Additional articles about gastric bypass surgery and general facts, advice and information about gastric bypass surgery may be found by visiting

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