Weight Loss Surgery - How do you know if your insurance will pay for the procedure

02-03-2003, 04:51 PM
my husband and I both carry insurance, he has a PPO and I have a HMO. How can i find out if they will cover this procedure? do you have to be at medical risk? I need to do something to get healthy and have thought about this for sometime now. PLease if anyone can give me some information I would appreciate it.

02-03-2003, 06:32 PM
hi michelle!

this isn't an easy decision to make, and it's not a quick fix, so be sure to do your research.

the simplest way to find out if your insurance covers the procedure is to call them and ask. but there are always some requirements that have to be met. first, you have to have a BMI of at least 40, which translates to being about 100 pounds overweight. you can also qualify if you are about 80 pounds overweight IF you have certain medical conditions, such as diabetes, hypertension, and sleep apnea.

and if you have any of these conditions, and are 100 pounds or more overweight, your case is stronger.

a warning: many insurance companies are now requiring 6 months of a physician-supervised weight loss plan. this can be a range of things, so check with your insurance company for the details on exactly what they require. many of us have already had this long history, so it wasn't a big deal. others, however, have fought the battle on their own or have completely avoided doctors.

oh. and some carriers won't touch the lap band, but will cover the rny and duodenal switch...

good luck and keep posting!

02-03-2003, 07:53 PM
Hi Michelle, wanted to welcome you.

Let us know what you find out.