Is Gastric Bypass Covered By Insurance?

Is Gastric Bypass Covered By Insurance?

Gastric bypass surgery is a standard weight loss procedure that helps people lose weight by restricting the amount of food they can eat and reducing the absorption of calories. Another joint bariatric surgery is the gastric sleeve, which removes part of the stomach and reduces its size.

Read more: The difference between gastric sleeve and gastric bypass.

While both procedures are effective in helping people lose weight, they can be expensive, so many people wonder if their insurance will cover the cost of gastric bypass surgery. The answer to this question depends on many factors, including your policy and applicable coverage requirements. We will explain these factors in more detail next.

When Does Medicare Cover Gastric Bypass Surgery?

Medicare is the US Government health insurance plan for the elderly and disabled, and it may cover gastric bypass surgery in some cases. Generally, coverage of this procedure is subject to certain conditions and criteria being met. These include:

a) The gastric bypass surgery is deemed medically necessary: The medical necessity of the operation must be established before any coverage can be granted.

b) The beneficiary has a body mass index (BMI) greater than 35 and at least one obesity-related condition that could improve with bariatric surgery, like type 2 diabetes or sleep apnea.

c) The beneficiary has not had bariatric surgery before.

d) The procedure is performed at a Medicare-approved hospital or ambulatory surgical center.

e) The beneficiary must choose a qualified gastric bypass surgeon.

Although Medicare may cover gastric bypass in some cases, it should be noted that the coverage is generally limited. Depending on their plan, the patient may still be responsible for some of the costs. These include:

a) Co-payment: The patient may need to pay a co-payment for the procedure.

b) Deductible: A deductible is an amount the patient must pay before Medicare begins providing coverage. This can vary depending on the plan, but it usually ranges from $1000-$5000.

c) Out-of-pocket expenses: Out-of-pocket expenses refer to costs not covered by Medicare, such as medications, follow-up care, and other related costs.

When Does Medicaid Cover Gastric Bypass Surgery?

Medicaid is a joint federal and state program that can cover medical expenses for individuals with limited income or resources. Whether Medicaid covers gastric bypass surgery depends on the individual’s state of residence and specific coverage plan.

In general, most states’ Medicaid programs may cover gastric bypass surgery if all of the following criteria are met:

– The person has a documented medical condition associated with obesity, such as diabetes, hypertension, sleep apnea, or degenerative joint disease that could be improved by weight loss through gastric bypass surgery.

– The person has attempted and failed to lose weight through a medically supervised diet or other non-surgical means of weight loss.

– The surgery is performed by an approved Medicaid provider in an approved facility.

How Does Private Insurance Cover Gastric Bypass Surgery?

Private insurance plans vary, but many do cover at least some of the cost associated with gastric bypass surgery. Generally, your plan will cover medically necessary surgeries such as this if it is deemed a reasonable and necessary treatment for the condition being treated. However, coverage may depend on your specific policy and what is outlined in the fine print of your plan.

Before you consider undergoing gastric bypass surgery, you must contact your insurance provider to understand if and how much coverage is available for your procedure.

Contact Dr. Renfrow for the best gastric bypass surgery in Miami. Our team of compassionate and experienced medical professionals is dedicated to helping patients get the care they need.

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