Gastric bypass surgery, otherwise known as a roux-en-Y gastric bypass (RYGB), is the oldest bariatric procedure that is still performed by surgeons today. Its introduction was a breakthrough for treating obesity and thousands of Americans undergo the procedure every year.
The one big barrier to gastric bypass surgery, even today, is the cost. The average cost of gastric bypass surgery is between $18,000 and $22,000, and most people are not going to be able to afford that. Therefore, it’ll be up to their insurance to determine whether or not they’re going to be able to afford the procedure.
In this article, you will learn about whether or not your insurance covers gastric bypass.
Will Insurance Cover Gastric Bypass Surgery?
The answer is yes. The following bariatric procedures are covered under most insurance schemes: gastric bypass, gastric sleeve, and adjustable gastric band. Newer procedures or revision surgery might be a little bit more of a problem, though. To see what insurance covers gastric bypass, as well as their requirements for approval, check out this guide to Insurance Coverage for Bariatric Surgery.
Does Medicaid cover gastric bypass surgery? The answer to that is that it depends. Medicaid’s coverage differs by state, and not all states will cover the same procedures. To see if your state’s Medicaid covers gastric bypass surgery, click here to go to the official government website for Medicaid and check your state’s coverage.
What Are The Requirements To Get Gastric Bypass Surgery Covered?
All insurance providers have different requirements for gastric bypass surgery. Not all providers will cover the same people, and depending on your qualifications, you may want to look at other options for paying for gastric bypass surgery.
However, the requirements generally follow the same pattern. To qualify for gastric bypass surgery, you must:
- Have a BMI over 40, OR
- Have a BMI over 35 AND have one or more of the following obesity-related conditions: high blood pressure (hypertension), type 2 diabetes (T2DM), or sleep apnea;
- Have a record of attempted weight loss with no lasting success
These requirements are there to make sure that bariatric surgery can be provided to those who need it most. Gastric bypass surgery is a big commitment and it’s expensive to provide. For this reason, only people who meet the qualifications are recommended for this surgery.