Do You Meet Your Health Insurance Provider’s Requirements for Weight Loss Surgery?

The cost of weight loss

Do you meet the criteria many health insurance providers require before covering your weight loss procedure? Here are some facts about the cost of losing weight for you and everyone else.


With the majority of obese patients finding that losing weight—and keeping it off—is nearly impossible for them using conventional dieting and exercise, many are turning to some form of bariatric surgery to give them the extra help they need to finally shed those unwanted pounds. But it’s really more than just about slimming down and looking better and healthier, it’s really about helping them become cured of metabolic disease syndrome—especially the threat of diabetes that might be reduced with antioxidants.

Unfortunately, however, not everyone looks at the big picture of what it means cost-wise when it comes to the fact that up to two-thirds of the American population is classified as being overweight or obese.

This was the message of a recent news investigation made by ABC affiliate station WAAY31 in Huntsville, Alabama that found that the cost of obesity-related diseases was an estimated $147 billion with another $3-5 million added in from lost working hours for many businesses due to obesity-related illness. That, and the fact that weight loss surgery may be the answer as demonstrated by one example of a local woman who lost 70 pounds and lowered her cholesterol from 256 to 150 after having gastric sleeve surgery.

So then, in spite of reports of the success rate revealed with bariatric surgery for losing weight, why aren’t more obese people going in for weight loss surgery or encouraged to by their employers? The short answer is that it costs too much. The longer answer is the fact that while most insurance companies do cover obesity-related illnesses, they do not financially cover obesity-related surgery or other weight loss measures.

According to the WAAY31news report:

“In the United States only 37% of health plans sponsored by employers cover bariatric surgery, a procedure that reduces the size of the stomach, leading to weight loss for most patients. That's according to benefits consulting firm Mercer. The lack of coverage forces some patients to pay out of pocket for the surgeries, which can cost anywhere from $10-30,000.”

Insurance Provider Requirements for Weight Loss Surgery

As it turns out, the aforementioned local resident who lost so much weight and significantly improved her cholesterol levels was able to do so only by paying for the surgery out of her own pocket. She, the news report revealed, fell between the cracks of coverage by not meeting the requirements specified by those insurance companies that do offer coverage for weight loss surgery. Typically, to qualify for coverage you have to:

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• Have a BMI of at least 40.

• Have at least two medical conditions like diabetes or high blood pressure with a BMI of at least 35.

• Have medical records proving that you have been obese for at least three years.

• Have completed at least six months of a physician-supervised weight loss program or commercial program such as Weight Watchers or Jenny Craig—but at your personal expense.

Dr. Ravindra Mailapur, who provided the local resident with her weight loss surgical procedure, pointed out that he believes that insurance providers would benefit in the long run by offering coverage for these types of surgeries because it would decrease the dollars spent on treating obesity–related illness such as with expensive prescription meds.

"In the long term it does benefit because a lot of these patients who are on an average of 5 to 15 medications, they get off their medications," he said.

This reluctance for coverage may have to do with most employers not anticipating any financial benefit in the long term due to that most employees are unlikely to be with the same company for life. Furthermore, even the Affordable Care Act doesn't support weight loss procedure coverage.

For now the chance that the insurance coverage situation will improve anytime soon is unlikely. In addition, for those who do work for companies with insurance plans that do cover weight loss surgery, they can expect rising insurance premiums to help support the coverage.

For an informative article about what you need to know about seeking less expensive weight loss surgery in foreign countries, here is a warning about how Medical Tourism Can Be Fatal for Dieters.

Reference: ABC affiliate station WAAY31 Huntsville―”INVESTIGATORS: The Cost of Weight Loss