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Does My Insurance Cover Weight Loss Surgery?

Posted on 25 May, 2022
Does My Insurance Cover Weight Loss Surgery?

If you are considering weight loss surgery, you likely have a lot of questions, most significantly about the cost. One of the most common questions is whether or not health insurance will cover the procedure. The answer to this question depends on your specific policy. In this blog post, we will discuss whether or not insurance typically covers weight loss surgery, looking at the general gastric sleeve cost Australia and what you can do if your insurance doesn't cover it.

Defining Weight Loss Surgery

Before we delve into the nuances of weight loss surgery and health insurance, let’s start by defining the most common types of weight loss surgery in Australia.

There are many different types of weight loss surgery, but the most common are gastric bypass, sleeve gastrectomy, and lap band surgery. Each type of surgery has its own risks and benefits, so it's important to talk to your doctor about which one is right for you.

Gastric bypass surgery is the most common type of bariatric surgery. It involves creating a small pouch in the stomach and connecting it directly to the small intestine. This allows food to bypass the rest of the stomach and intestines, which can help you lose weight.

Sleeve gastrectomy is another common type of weight loss surgery. It involves removing a large portion of the stomach, leaving only a narrow sleeve of stomach remaining. This can help you lose weight by making you feel full more quickly and eating less.

Weight loss surgery is a serious decision, and it's important to talk to your doctor about all of your options before deciding if it's right for you. There are risks and benefits to all types of any procedure, so make sure you understand everything before making a decision.

Does My Insurance Cover Weight Loss Surgery? Check Your Policy

Most insurance companies consider weight loss surgery to be a cosmetic procedure. This means that they are not required to cover the cost of the surgery. However, some insurance companies will cover the cost of weight loss surgery if it is deemed medically necessary. To determine whether or not your insurance company will cover the cost of weight loss surgery, you will need to contact them directly and ask, or check the information within your specific policy.

Your Options When Weight Loss Surgery is Not in Your Policy

If your insurance company does not cover the cost of weight loss surgery, you may still be able to get the surgery covered by another type of insurance. For example, some employers offer health insurance that will cover weight loss surgery. You can also look into getting a supplemental policy that will cover the cost of a procedure.

No matter what, it is important to do your research before getting bariatric surgery. This way, you will know what to expect and how to finance the procedure. If you have any questions, be sure to contact the team at Central Coast Surgery – our helpful and friendly team within the clinic will be able to help you figure out whether or not insurance will cover the cost of your surgery.

Appealing Health Insurance Policies on Medical Grounds

If your insurance company does not cover the cost of weight loss surgery, there are a few options available to you. You may be able to appeal the decision by providing documentation from your doctor showing that the surgery is medically necessary.

Additionally, some insurance companies will offer partial coverage for weight loss surgery. This means that they will cover a portion of the cost of the surgery. Finally, you can always pay for weight loss surgery out-of-pocket.

Health Insurance That Covers Weight Loss Surgery Australia

Heath Insurance policies vary when it comes to covering weight loss surgery. It is important to do your research into the policy you are currently on to see if it covers bariatric procedures. For private health insurance, obesity is generally considered a pre-existing condition, as such you will be required to wait twelve months before you can claim any benefits.

Most of the top private health funds will have policies that cover bariatric surgeries, normally included within the ‘Gold Level’ ranking and above.

To speed up answering does my insurance cover weight loss surgery? Look for their Medicare Benefits Schedule number (MBS) on your policy guide.

  • Gastric banding: Item 31569
  • Gastric bypass: Item 31572
  • Duodenal switch: Item 31581
  • Reversal of Gastric Banding/Lap-Band (removal or replacement of gastric band): Item 31584

Does Medicare Cover Weight Loss Surgery?

As mentioned some weight loss surgery procedures in Australia are covered, or partially subsidised, by private health insurance. This includes gastric sleeve surgery, which is the most common type of weight loss surgery.

However, Medicare, the publicly-funded health care insurance service in Australia, does not cover wieght loss surgery. 

Wrapping Up

Weight loss surgery can be a great way to improve your health and quality of life. If you are considering the procedure, be sure to do your research and talk to a weight loss surgeon about your options. With the right planning, you can get the surgery you need without breaking the bank.

Weight loss surgery is a big decision. Be sure to do your research and make an informed decision about whether or not it is right for you. And if you have questions about whether or not your insurance will cover the cost of the surgery, make sure to ask your provider.

Bariatric surgery is an expensive procedure, whether it is partially covered by your insurance. It is a life changing operation that can greatly improve the quality of life of patients struggling with their weight.

Weight Loss at Central Coast Surgery

At Central Coast Surgery, our team are passionate about helping patients feel more comfortable with their weight and help treat the long-term effects of obesity. Led by Dr Ken Wong, our team of dieticians, weight loss doctors, and exercise physiologists, our team is here to help achieve long term weight loss goals.

If you have any questions or would like to schedule a consultation at our practice, please contact us. We would be more than happy to help you on your weight loss journey! Visit our site to learn more about the different types of weight loss surgery we offer and booking in a consultation online today.

Note: This blog post is for informational purposes only and does not constitute medical advice. Please consult with your doctor before making any decisions about weight loss surgery. Results may vary from person to person.