With Open Enrollment Around the Corner, Now Is a Good Time to Consider Your Insurance Options

Nov 09, 2016

With Open Enrollment Around the Corner, Now Is a Good Time to Consider Your Insurance Options


According to American Society of Metabolic & Bariatric Surgery, insurance denial and unattainable prerequisites were the two most common reasons why some patients do not undergo bariatric surgery. About 25 percent of patients considering it are denied coverage three times before getting approval.

Health insurance companies might not pay for weight-loss surgery, but do pay for years of treating the conditions associated with obesity such as diabetes, heart disease, sleep apnea, high blood pressure, hyperlipidemia, and many many others. Mounting evidence shows that surgery for morbid obesity can be more cost-effective than treating the conditions resulting from obesity. In fact, laparoscopic gastric bypass (and likely sleeve gastrectomy) pay for themselves within two years…And that comes straight from hospital and insurance company and managed care journals. But they still put up hurdles to discourage patients from seeking it.

It’s highly unlikely that you’ll find an individual health plan that won’t cover weight-loss surgery, including the Obamacare plans in California (aka California Exchange Plans). They usually do including Medicare and MediCal. Group health plans however may not cover bariatric surgery if an employer specifically selects it out as an option. Only six states mandate that treatment for morbid obesity be covered by group health plans: Georgia, Illinois, Indiana, Maryland, New Hampshire and Virginia. These mandates apply only to group plans but not necessarily those offered by self-funded companies. That’s where large employers take on their own financial risk of covering employee claims, and you probably won’t know if your employer is self-funded unless you ask.

So bottom-line, just because you have insurance does not mean that bariatric surgery is a covered benefit. That is why you have to take charge and start doing your homework now during open enrollment for 2017. Some strategies to consider include:

1. If your HMO plan doesn’t cover obesity surgery, change to a PPO plan at open enrollment if the PPO plan covers it.
2. Change to your spouse’s plan if it provides coverage.
3. Get a job with large employers that cover weight-loss surgery as a commitment to employee health (plus it saves them money in long term). According to ASMBS, examples include: Intel, Toyota, FedEx Freight, and Harrah’s and Caesar’s Palace.
4. Consider paying out-of-pocket for the surgery part. It is a lot cheaper than you think.

If you are suffering from obesity and tired of yo-yo dieting and drugs and fads, it’s of the utmost importance that you seek the most effective and progressive treatment options available to you. At University Bariatrics we consider all the options during your consultation, and help create a customized weight loss plan to help you along your journey to a healthier life. Call us or visit us on the web to attend a free bariatric surgery seminar and set up your personal private consultation.

University Bariatrics