Most insurance companies in the USA pay for bariatric surgeries (weight loss or obesity surgery). But the process to obtain approval is a lengthy one & not all qualify due to it. The patient needs to establish a medical necessity. Following are the points they consider:
- BMI of 40 or higher and morbidly obesity. BMI is a number calculated from a person’s weight and height and is used as an indicator of body fatness to categorize obesity.
- Prove obesity as an issue for more than five years
- Have exhausted all serious efforts to reduce weight by non-surgical methods (pills, exercise, dieting, creams & location, special clothing etc).
- You have co-morbidities (Medical illnesses/diseases that are either caused by or contributed to by morbid obesity. For example, diabetes, high blood pressure, high cholesterol, sleep apnea, and arthritis)
Along, with this the patient also needs to provide the insurance company data about their:
- Medical condition related to liver, kidney, or any gastrointestinal disease
- Thyroid Test Results
- Any history of alcohol or substance abuse
It makes business sense for health insurance companies to pay for weight loss surgery. There is a number of health risk associated with obesity that would cost the insurance companies more money if the bariatric surgery is not performed upfront.
Health risks associated with obesity are heart disease, arthritis, high blood pressure, type 2 diabetes, gout, lower back pain, pregnancy complications, bladder control problems and cancer to name a few. Additions to this are psychological disorders like low self esteem, depression & eating disorders.
According to United States, government research report published in New York Times in 2004, obesity is near to overtaking smoking as the No. 1 cause of death in the United States(tobacco related deaths are still number 1 with 18.1 percent). According to a November 2007 report by National Center for Health Statistics obesity rate in the United States was 34 percent (U.S. adults aged 20 and over). Obesity by them is defined as a body mass index (BMI) of 30 or greater.
The stringent requirements that a patient has to meet for bariatric health insurance benefits, discourages many from being able to avail the weight loss surgery benefits of their health insurance plan(even if their insurance policy covers it).
A viable alternative that is being explored by many is for affordable overseas bariatric surgeries. These include common bariatric surgery like lap band, gastric bypass & gastric sleeve surgery. Popular destinations for US patients seeking cost effective bariatric surgery is Mexico & Costa Rica. Many surgeons at these overseas location have more experience than their US counterparts. Many times the total cost of surgery and travel expenses combined, is still less than the cost the patient would pay if the insurance paid its part of the medical insurance coverage.
For patients that do not have their insurance covering bariatric surgery in the USA, Medical Tourism Corporation helps with high quality bariatric surgery hospital & centers overseas. A page that has links to articles on weight loss (bariatric) surgery can also accessed for more information and knowledge.