How to Get gastric sleeve covered by insurance?

Gastric sleeve is a weight loss surgery that involves removing 80% of the stomach by inserting small instruments through small incisions in the upper abdomen region. The purpose of this procedure is to limit the amount of food the patient consumes, which further helps prevent heart problems and other conditions.

If you are considering getting a gastric sleeve done anytime soon, do not forget to cover it under health insurance. 

How To Get Insurance To Pay For Gastric Sleeve?

Today, most insurance companies cover weight loss surgeries, including gastric bypass, gastric sleeve, and gastric band, when they become a medical necessity. However, insurance plans require a medical necessity to be proven before covering weight-loss surgery. Therefore, in addition to your discussion with them, you must also provide documentation that the patient needs weight loss surgery. 

How to Get gastric sleeve covered under insurance?
S. No.CriteriaDescription
1Age above 18The patient must be a legal adult (18 years or older) to undergo gastric sleeve surgery.
2Body Mass Index (BMI)Companies require a BMI of 40 or higher for gastric sleeve insurance coverage. A BMI of at least 35 may be considered if the patient has co-morbid conditions.
3Smoking historyPatients should not show signs of smoking or substance abuse before scheduling the gastric sleeve surgery.
4Earlier weight-loss journeyInsurance companies often require that patients have made significant efforts to lose weight before approving coverage. This can include following a medically supervised weight-loss plan or receiving guidance from a doctor for three to seven consecutive months.
5Psychological evaluationPatients are typically required to undergo a psychological examination to ensure they have realistic expectations for the surgery’s outcome and possess the necessary knowledge and support for long-term success. The evaluation may include assessing eating behaviors, reasons for pursuing gastric sleeve surgery, weight loss history, and psychiatric history.

For patients who meet the requirements, several bariatric operations, like laparoscopic banding surgery and gastric bypass surgery, are covered by Medicare and Medicaid.

States Where Insurance Is Necessary For The Surgery (Under ACA’s Essential Health Benefits(EHB) Benchmark Plans)

  • Arizona
  • California
  • Colorado
  • Delaware
  • Hawaii
  • Illinois
  • Iowa
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Rhode Island
  • South Dakota
  • Vermont
  • West Virginia
  • Wyoming

How to prepare for the gastric sleeve?

It is important to prepare well in advance once the gastric sleeve gets scheduled so the procedure is smooth and the patient’s body heals better. The patient has to ensure that they consider what they are consuming; generally, it is advised to follow a certain program. Drinking, substance abuse, and smoking are highly restricted.

Conclusion

If you meet the criteria and are from one of the states, claiming the insurance will not be a hassle. That being said, other states also offer insurance for various gastric surgeries.

We hope this article helped our readers dive deep into the medical procedure of gastric sleeves and its coverage under insurance. Do not forget to check out our website for more such content.

Also, read: DOES KAISER COVER OZEMPIC FOR WEIGHT LOSS?

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