Article submitted by DHR Health Bariatric And Metabolic Institute
Obesity has become a common problem in the United States. While diet and exercise work for many people, others choose to utilize bariatric surgery in their quest to lose weight. However, insurance requirements vary and many insurances simply do not cover bariatric surgery at all. Does Medicare cover bariatric surgery?
The answer is not a simple yes or no. Original Medicare (not an HMO or PPO through Medicare) may cover bariatric surgery depending on certain criteria. To find out about the HMO or PPO versions of Medicare please refer to their customer service helplines for more information.
The simple criteria set forth by Medicare for covering bariatric surgery can be found on the Medicare.gov website. This is not a comprehensive list of eligibility requirements. The Medicare website simply states that they may cover some forms of bariatric surgery and suggests talking to your doctor for more information.
That said, the Centers for Medicare and Medicaid Services (CMS) have a much more in-depth page of information regarding what steps Medicare requires for bariatric surgery. According to their information, weight loss surgery may be covered if the following indications are found:
1. A body mass index over 35.
2. At least one co-morbidity related to obesity.
3. Being unable to maintain successful weight loss.
If you have Medicare and are not sure if you would qualify for bariatric surgery the first person you should discuss this with is your primary physician. They can record your height and weight to see if your BMI is over 35. Your doctor may also do a routine physical and blood work to see if you have any co-morbidities related to obesity. Sometimes patients are referred to a sleep lab to check for sleep apnea which is a common issue for obese patients. Your physician may also begin to see you on a monthly basis to record your weight which shows your success rate in regards to weight loss. During this time you can follow up with a bariatric clinic that accepts Medicare. Between your doctor and your bariatric clinic, your road to qualifying for insurance approval should go smoothly, if you do qualify.