Health & Medical Lose Weight

What Is Needed in Order for Insurance to Cover Obesity Surgery?

    Prove Your Physical Condition

    • Insurance companies have some general guidelines to determine whether you are in need of the surgery physically. You must have a body mass index (BMI) of more than 40, with no health-related problems due to your obesity, or a BMI between 35 and 40, with obesity-related health problems, such as diabetes or high blood pressure. Your doctor must provide paperwork confirming your health conditions, with an official BMI reading.

    Ready Yourself Psychologically

    • In addition to the physical rigors of surgery, there are some psychological considerations. Insurance companies want to know that you are stable enough to undergo this procedure, particularly since it alters your appearance so drastically. Many people struggle with the fact that they look so different and are no longer obese. While this is positive, the transition can be mentally challenging. Schedule one to two sessions with a counselor who specializes in counseling patients undergoing obesity surgery. He will help determine whether you are having the surgery for the right reasons and whether you are a good candidate for the procedure. He will submit your evaluation to your doctor's office, which will pass the information on to the insurance company.

    Prepare Extensive Paperwork

    • In addition to proving your physical and psychological condition to the insurance company, they will need a significant amount of paperwork. You must provide a detailed, written history of your previous attempts to lose weight, which, with most health insurers, must include a doctor-supervised diet. Blue Cross National CareFirst and Blue Cross Blue Shield of Florida require a six-month diet before procedure approval, according to the ObeseInfo website. First Health requires patients to undergo a multi-disciplinary diet approach for three months before providing approval. Be prepared to provide a specific dietary history before your insurance company will approve you, including any attempts at Weight Watchers, Jenny Craig or any other common weight loss program.

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