Gastric sleeve surgery, or sleeve gastrectomy, is a type of bariatric surgery used to help people with severe obesity lose weight. The procedure involves removing a large portion of the stomach, leaving a tube-shaped stomach, or a “sleeve.” In general, insurance companies consider gastric sleeve surgery to be a medically-necessary procedure for people with severe obesity who are unable to make meaningful progress with diet and exercise. Most health insurance plans, including employer-provided insurance plans and government-sponsored programs like Medicare and Medicaid, cover some or all of the cost of gastric sleeve surgery. However, insurers typically require that people meet strict criteria in order to be eligible for coverage.
This criteria can vary from plan to plan, but generally includes: -A BMI over 40, or 35 for those with co-existing medical issues -A documented, serious weight-related medical condition that has not improved with lifestyle changes -A trial period of medically-supervised weight loss -Psychological evaluation To determine eligibility, insurance companies typically require that you provide paperwork from your doctor and a weight-loss specialist. They may also require that you participate in educational programs, such as those offered through a bariatric clinic or hospital, in order to ensure you understand the risks and responsibilities associated with the surgery.
In some cases, insurance companies may require that you lose an amount of weight before they will cover gastric sleeve surgery. This preoperative weight loss may be recommended as a way to reduce the risk of post-surgical complications. Preauthorization for gastric sleeve surgery is usually required in order for your insurance company to cover the procedure. This is a process in which you and your doctor submit paperwork to the insurance company detailing why you should qualify for gastric sleeve coverage and how you plan to achieve your weight-loss goals. Preauthorization is usually an involved process and can take a few weeks to complete.
Getting insurance coverage for gastric sleeve surgery is possible, but it is important to remember that insurance companies may deny coverage if you don’t meet their criteria or if you have too many post-surgical risks. Be sure to check with your insurance provider ahead of time in order to be sure that you will be covered.