Insurance FAQs

Insurance can be one of the most important factors in moving forward with weight loss surgery. And while most insurance plans cover bariatric surgery, your coverage may depend on your medical history, insurance policy and benefit, or exclusions.

That’s why it’s important to have a discussion with your provider about what’s covered and what’s not. Get the information you need, and if something isn’t making sense, ask them to explain it again or in a different way.

To help you better understand what to expect, here are some common FAQs to consider.

How does an insurance company’s approval process work?

While all insurance companies are different, many of them look for similar criteria when deciding whether or not to approve weight loss surgery. Some (but not all) of the things they may look for include:

Documentation that you have a BMI of 40 or above
Documentation that you have a BMI of 35 to 40 with additional conditions, such as diabetes, sleep apnea, high blood pressure or high cholesterol
Documentation of your weight history for the past two years
A record that you’ve participated in a medically supervised weight loss program
Confirmation you’ve consulted with a registered dietitian
Confirmation you’ve consulted with a psychologist

What affects the cost of weight loss surgery?

The cost of bariatric surgery depends on several factors. The most important of these is whether or not weight loss surgery is covered by your health insurance plan. It helps to find out if the Center for Weight Management is a preferred or out-of-network provider under your plan. You may also want to look at what co-pay and deductible amounts apply to you.

What health plans are accepted at Virginia Mason Franciscan Health?

Please check to make sure bariatric surgery is not an exclusion on your individual plan. The employer chooses annually, whether to cover bariatric surgery for individual plans so some plans may not be covered. Coverage differs from site-to-site. Please check with clinic staff to verify your insurance coverage.

Find more insurance-related information here.

The following health insurance companies recognize Virginia Mason Franciscan Health as a preferred provider of bariatric surgery:

What can I do if my insurance company doesn’t cover weight loss surgery?

If bariatric surgery isn’t covered through insurance, you may choose to pay for it yourself. The Internal Revenue Service allows you to take a tax deduction on any out-of-pocket costs you incur from a physician-directed weight loss program. This includes what you pay for bariatric surgery – but does not apply to any portion of money that insurance pays.

We offer a special rate for patients paying out-of-pocket.

(Please note: Virginia Mason Franciscan Health is not contracted with Care Credit.)

If I’m paying for surgery myself, how much does it cost?

Good question! For patients who are paying for some or all of their weight loss surgery, the cost can range from $16,000 to $20,000. To help support you on your journey, the Center for Weight Management can provide you with comprehensive pricing packages that can include:

Surgeon’s surgical fees
Surgical assistant’s fees
Hospital’s surgical fees
Postoperative visits for the first 90 days
Anesthesiologist fees
Nutritional counseling

How long does it take to schedule surgery?

This depends on your insurance requirements. It can take anywhere from 1 - 6 months before submitting to insurance for approval and then 6 - 8 weeks for your insurance to approve the operation.

Why does it take so long to get insurance approval?

It’s a multi-step process, and the length of time varies depending on the insurance company. Once all of the insurance requirements are met, it usually takes us one to two weeks to send a letter to your insurance carrier to start the approval process. Typically, the time it takes to get an answer back is from about two to six weeks -- or even longer if the carrier is not prompted. A call made directly by you, to the insurance company, to inquire about your request may help to speed the process along.

How can an insurance carrier deny coverage for a life-threatening disease?

Coverage may be denied because there is a specific exclusion in your policy for obesity surgery or treatment of obesity. If there is a written exclusion stated in your policy, ask your employer about other policies. There may even be a short-term policy that can be used. When there is only one policy, and a written exclusion is listed, it might be time to look for other options such as self-pay and/or medical loan programs.

Do you qualify for weight loss surgery?

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Interested in weight loss surgery?

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