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Why Doesn't My Insurance Cover The Gastric Sleeve Procedure?

Why Doesn't My Insurance Cover The Gastric Sleeve Procedure?

 

That's a question I get just about every day. And my answer is usually the same! The insurance company says your policy doesn't cover it! You pull out the policy and read all the fine print, then discover that although it looks like it might be covered there are some stipulations

 

Unfortunately, the insurance company dictates the rules and in most cases your BMI (Body Mass Index) needs to be above a certain criteria (the majority is over 40) with one or more life threatening illnesses. These could include Type 2 diabetes, sleep apnea, heart disease and host of other health related issues. 

 

The majority of US health insurance plans do not cover VSG (vertical sleeve gastrectomy) as a stand alone procedure as it's considered elective or cosmetic surgery.

 

Did you know that Blue Cross-Blue Shield of Arkansas requires a BMI of 60 or higher to even be considered for the surgery? Which is kind of ironic considering Arkansas has the highest obesity rate in the United States. That 60 BMI is the equivalent of a 5'11'' 45 year old male weighing about 430 pounds...which is about 200 pounds over the accepted limit for the age and height.

 

But what about Medicare and Medicaid?

 

If you're 65 and older and currently on Medicare the chances your insurance will cover the procedure is ...well, currently none! But like all things run by the US Government they are taking a “wait and see” approach and may one day cover it. Although I wouldn't cross my fingers. Another US Government program which is designed to help low income families obtain insurance is called Medicaid, unfortunately the option to cover certain medical procedures is left up to each State. Again the chances are very low that weight loss surgery is covered. 

 

Now if somehow by chance your insurance does cover the procedure you might have to use the doctors they recommend, unfortunately most insurance doesn't cover medical tourism. Yet!

 

But that could be changing!

 

According to the Centers For Disease Control and Prevention about 750,000 Americans travel abroad for their healthcare. Some insurance companies are exploring the option to cover medical tourism as the costs for surgery are normally cut in half versus the American price of the same surgeries.

 

If you don't want to wait for the insurance to decide

  • if they are or aren't paying for it,

  • when and if they will pay for it,

  • where you will need to go for surgery,

  • what your deductible will be,

  • what restrictions you will have,

  • or any other reason the insurance may give...

...may I suggest you learn everything you can about the gastric sleeve procedure so you know what to expect if you elect to travel out of the country to receive your weight loss surgery.

 

Here's a few of our blog articles to help you in case you missed them.

Treating You Like Family 

Explaining To Friends and Family Why Gastric Sleeve Surgery In Mexico 

Making It Easy For You To Decide 

You Get What You Pay For

 

 

In the almost 10 years since we started offering the gastric sleeve procedure  over 9000 patients have trusted us for their surgery. That's over 9000 patients that might have not received the life changing procedure if they had waited for their insurance company to decide what they should do. So, if you're tired of waiting, I invite you to check us out, learn more about weight loss surgery and how medical tourism could benefit you.

 

 

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