Bariatric Insurance Coverage
Most insurance companies offer benefits for bariatric surgery. Your employer selects your benefits and makes the decision to offer bariatric coverage. Your Benefits Handbook provided by your employer will list all of your benefits including benefits for bariatric surgery.
NOVA Weight Loss will make every effort to accurately verify your benefits prior to your consultation if you have provided us with your complete insurance information at the seminar. Nova Weight Loss, however, can not be held responsible for information reported to us by your insurance company in error.
Over 90% of our clients are able to use their private insurance to cover their bariatric surgery. After the 1991 National Institute of Health Consensus conference, the federal government mandated coverage for all federal employees. This opened the door for most insurance carriers to investigate offering bariatric surgery coverage for their plan holders. In 2006, The Center for Medicare Services Administration standardized coverage for bariatric surgery for all Medicare and Medicare recipients.
With the increasing awareness of the benefits of bariatric surgery, the costs to the insurance providers have increased sharply. Many plans now have specific requirements that have to be met to allow access to coverage for surgery. It is worthwhile to note that bariatric surgery is the ONLY area of medicine to be subjected to this kind of scrutiny when predetermining coverage. Our staff has many years of experience working with the insurance companies and enjoy a high success rate of approvals for our clients.
Below is a brief listing of some of the larger insurance companies and their coverage criteria:
Universal Treatment Requirements:
- NIH criteria for surgical treatment of obesity:
- BMI greater or equal to 40 (80-100lbs overweight)
- BMI greater or equal to 35 with presence of severe co-morbid condition such as diabetes, hypertension, sleep apnea, or heart disease
If you have a BMI below 35, your insurance will not provide coverage for surgery. However you may be considered for surgery on a self-pay basis.