Insurance coverage varies greatly; read your policy carefully. Don’t rely on a verbal response over the phone from a company representative.

Many companies cover all of the surgical procedures as long as the patient satisfies the NIH criteria described above. Some companies cover only some of the procedures; for example, the gastric bypass and not the adjustable gastric band. Currently, very few insurance companies cover the gastric sleeve.

Many insurance policies cover one or more of the surgical procedures, but require candidates to satisfy additional criteria, such as participation in a six-month physician-supervised weight-loss program. Additionally, some companies claim they cover the procedures, but require the purchase of a rider exclusively for weight-loss surgery. Unfortunately, some insurance companies do not cover weight-loss surgery at all.

If you do receive a denial, carefully read the reasons for the denial. As long as surgery is a covered benefit of the candidate’s policy, there are avenues for appeal. Sometimes the denial is merely the result of insufficient documentation or can be reversed by submitting additional information.

The only way to know is to ask. Find out whether your insurance company ever covers weight-loss surgery, and, if so, what restrictions and requirements it has. Some tips: 

• Get the name and position of the insurance representative you are talking to. 
  
  
• Whenever possible, get information in writing. 
  
  
• Don’t think your primary doctor or surgeon can “get around” an insurance policy that doesn’t cover weight-loss surgery, or that if your plan covers surgery it will cover this particular surgery. Neither belief is likely to be true. 
  
  
• If your insurance doesn’t cover weight-loss surgery, ask your company if they might change insurers in the future. You may also want to look at other insurance options during the next open enrollment period.
  
  
• If there’s really no chance for insurance coverage, consider paying for the surgery yourself. Financing options are usually available. After all, which is more important: a new car or a new life? If you go this route, find out whether your insurance would cover complications that might arise from the surgery, such as a blood clot or pneumonia. While the surgery might be affordable in your budget, complications may not be.

When you contact a weight-loss surgery program, you’ll find that the practice has its own staff to help you manage insurance and financial issues. They’ll talk with you about all your concerns regarding your insurance policy. Staff members usually are pretty good at helping you.

However, it’s still important to be familiar with your own insurance policy. Some policies cover the operation, but, more than likely, the insurance company will require a “letter of medical necessity” from both the surgeon and your primary care doctor that details your obesity-related health conditions. You may also be required to meet with a registered dietitian and be evaluated by a psychologist. Your surgeon will help you with these referrals.

Some insurance companies require that you have participated in a physician-supervised diet and exercise program for six months. Your program staff can help you with this as well. Letters from any doctors who treated you for obesity-related conditions, especially diabetes, high blood pressure, cardiovascular diseases, dyslipidemia and arthritis, are also helpful.

Tenacity helps. Don’t take no for an answer. Working closely with your weight-loss surgery program gives you a good chance of having your surgery covered. Don’t give up.

Obesity surgery is known as elective surgery, so it’s not an emergency (even though it might seem like one!). Coverage varies. Most insurance companies do cover both the gastric banding procedure and the gastric bypass, but there are multiple requirements you will need to fulfill prior to the insurance company considering your claim. The first step: Call your insurance company to get specifics. Services range from complete coverage to partial coverage (you have a substantial copayment) to no coverage at all.

Most insurance plans require six months of a medically supervised lifestyle plan. This can be done with your primary care doctor or a medical-center clinic. Be aware that you must provide documentation of your food intake, physical activity and monthly goals. Your weight must be taken monthly, and most plans want you to remain “weight stable” (which can be zero pounds change, or up to five or more pounds) over that period. Check with your own plan for the specifics.

In addition, most plans require a psychological clearance and nutrition consultation to review the dietary guidelines of your surgery. Your surgeon will also be part of the comprehensive weight-loss surgery program to provide appropriate direction and guidance. This will optimize the likelihood that your case will be approved by the insurance company. If there is a denial of service, it is possible to appeal and resubmit with additional information.

If your insurance will not cover the operation, or if you are denied, you may want to consider paying for it yourself. While expensive, it is similar to a car loan, with inclusive costs ranging from $15,000 to $20,000 for a banding procedure, to about $19,000 to $27,000 for a gastric bypass. Many programs offer an extended payment plan.