How to get weight loss surgery approved by insurance?
Asked by: Ezequiel Barton | Last update: August 20, 2025Score: 4.6/5 (47 votes)
- Over age 18 (Some plans allow for surgery under age 18)
- BMI over 40 or BMI over 35 with high blood pressure, type 2 diabetes, or other risk factors.
- Documented weight loss efforts over a period of time.
- Weight loss program mandated by the insurance company.
- Psychological testing.
What do I say to get approved for weight loss surgery?
Your team will need to show that the procedure is medically necessary. Also, you may need to provide documented evidence that you weren't able to lose enough weight with a supervised program of diet and exercise. Medicare and some Medicaid programs may cover the costs.
Is it hard to get approved for weight loss surgery?
It is not particularly difficult for most people to get approved for bariatric surgery, but there are some steps one usually must go through. In the United States, bariatric surgery is considered medically necessary, and so it is a covered benefit by most public and private health plans.
What is medically necessary for weight loss surgery?
Body weight greater than 100 pounds or 45 kg above ideal weight. Body Mass Index (BMI) greater than 40 or BMI greater than 35 with medical complications related to obesity, including high blood pressure, type 2 diabetes, sleep apnea and gallbladder disease.
How much do you have to weigh for insurance to cover weight loss surgery?
Have a body mass index (BMI) of 35 or higher, or have a BMI between 30 and 35 and an obesity-related condition, such as heart disease, diabetes, high blood pressure or severe sleep apnea. Weigh less than 450 pounds, the maximum weight that hospital radiology equipment can accommodate.
Approval Process For Weight Loss Surgery 📝 How to get approved (Bypass, Sleeve, Band, Switch) ✅
Is it hard to get insurance approval for bariatric surgery?
In the U.S., many insurance plans cover bariatric surgery when a patient meets certain criteria. According to a recent survey of coverage criteria for bariatric surgery, 95% of companies have a clearly defined pre-authorization policy.
How much do you have to weigh to qualify for Ozempic?
Ozempic for medical weight loss is typically recommended for adults with a BMI of 30 or higher, or those with a BMI of 27 or higher who have weight-related health conditions like type 2 diabetes or high blood pressure.
What would disqualify you from weight loss surgery?
You have an inflammatory disease or condition of the gastrointestinal tract, such as ulcers, severe esophagitis, or Crohns disease. You have severe heart or lung disease that makes you a poor candidate for any surgery.
What is the strongest weight loss prescription pill?
Some of the strongest weight loss pills available today include: Naltrexone/bupropion (brand name Contrave) Phentermine/topiramate (brand name Qsymia) Orlistat (brand names Xenical, Alli)
How to get insurance for weight loss surgery?
- Over age 18 (Some plans allow for surgery under age 18)
- BMI over 40 or BMI over 35 with high blood pressure, type 2 diabetes, or other risk factors.
- Documented weight loss efforts over a period of time.
- Weight loss program mandated by the insurance company.
- Psychological testing.
How do people afford weight loss surgery?
Fortunately, California is one of 23 states that require individual, family, and small group insurance plans to cover bariatric surgery through the Affordable Care Act. Most people can obtain coverage for bariatric procedures through their PPO or Medicare. Exhaust these possibilities as a first step.
How to get approved for Ozempic?
Ozempic is a prescription medication primarily used to manage type 2 diabetes and is sometimes prescribed off-label for weight loss. To acquire Ozempic, you need a prescription from a licensed healthcare provider, which can be obtained through an in-person or telehealth visit.
How fast can you get approved for weight loss surgery?
If, after reviewing your materials, you are considered an appropriate candidate for weight loss surgery, it may take only two to three weeks for your initial consultation with the surgeon. The entire process takes about 60 to 90 days, depending on your preoperative requirements.
Why do people get denied for weight loss surgery?
Abstract. Background: Many patients who seek weight loss surgery are denied an operation because of insurance barriers, psychological concerns, and poor medical fitness for surgery.
What is one of the top 3 causes of death after bariatric surgery?
Results. 6118 patients underwent primary bariatric surgery. 18 deaths (0.3%) occurred within 30-days of surgery. The most common cause of death was sepsis (33% of deaths), followed by cardiac causes (28%) and pulmonary embolism (17%).
What to tell your doctor to get bariatric surgery?
Talk to your doctor about your weight loss goals: Discuss your weight loss goals with your doctor and explain why you believe surgery is the best option for you. Be sure to provide any relevant medical information, such as previous weight loss attempts or obesity-related health conditions.
Can you really get Wegovy for $25?
Yes, you can really get Wegovy for $25 if you meet certain criteria. Offered by Novo Nordisk, the Wegovy Savings Card awards qualified individuals the opportunity to get the medication for $25 per month (i.e. 28-day supply).
What did Kelly Clarkson use to lose weight?
She combined diet changes, such as adopting a lectin-free diet, with regular exercise like walking. Clarkson's journey included using weight loss medication, although she emphasized a holistic approach. Wellness trends like infrared saunas and cold plunges played a role in her transformation.
How to lose 50 pounds in 3 months?
- Eat fewer calories than your body needs to lose weight. ...
- Eat smaller meals more frequently. ...
- Include more protein in your diet. ...
- Increase your fiber intake. ...
- Drink plenty of water to stay hydrated and boost your metabolism. ...
- Cut out alcohol and sugary drinks. ...
- Add more whole foods to your diet and avoid processed foods.
How do I get approval for weight loss surgery?
Who Is Eligible for Weight Loss Surgery? To qualify for weight loss surgery, you must have either a: BMI of 40 or greater. BMI of 35‑40 with obesity-related conditions such as diabetes, high blood pressure, sleep apnea or gastroesophageal reflux disease (GERD)
Can you get gastric bypass at 200 lbs?
Weight Requirements for Gastric Bypass Surgery
However, a person who weighs 200 pounds could qualify for surgery if their BMI is 35 or higher and they have comorbid health conditions. This means that for a short person, 200 pounds could put them in the category of eligibility for surgery.
What makes weight loss surgery medically necessary?
In general, bariatric surgery could be an option for you if: Your body mass index (BMI) is 40 or higher, called extreme obesity. Your BMI is 35 to 39.9, called obesity, and you have a serious weight-related health problem, such as type 2 diabetes, high blood pressure or severe sleep apnea.
What insurance will pay for Ozempic?
Most major insurance plans, including commercial plans, Medicare, and many Medicaid plans will cover Ozempic for eligible patients with type 2 diabetes who meet the specific criteria outlined by the plan. Very few insurance plans cover Ozempic for people without type 2 diabetes at this time.
Can I lose 20 pounds in a month with semaglutide?
How fast you can lose 20 lbs on semaglutide (Wegovy) depends on your starting weight and other factors. If you weigh 232 lbs at the start of Wegovy treatment, you can expect to lose 20 lbs in around 16-20 weeks (4-5 months).
What to say to your doctor to get Ozempic?
Tell your provider why you're interested in Ozempic — a good doctor won't judge you or your desire to use a weight loss medication. They'll likely ask about your medical history, go over your eligibility, and consider anything that might make you a bad candidate for Ozempic.