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It depends on the terms of the insurance. Read the coverage document to determine if it specifically covers the procedure in question.


If it is deemed medically necessary & your insurance co turns you down you have every right to appeal their decision!

AnswerIf its an exclusion of the policy then it doesn't matter if its medically necessary or not.
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โˆ™ 2009-09-22 05:56:04
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Q: Can you be denied coverage for gastric bypass if it is medically necessary?
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Related questions

Will medicare pay for gastric bypass surgery?

Medicare does pay for the Gastric Bypass as long as it is proven to be medically necessary and the surgery is performed in a Center of Excellence facility.

When is gastric bypass surgery covered by insurance?

Gastric bypass surgery is generally covered by insurance when it is deemed medically necessary by a doctor. This basically means that in order for your gastric bypass surgery to be covered by insurance you would have to be very obese (not just overweight).

Where can I find out more about insurance coverage for gastric bypass?

Your insurance company can discuss insurance coverage for gastric bypass surgery with you. If you have a diagnosis of a weight-related disorder such as diabetes, coverage is common.

can i get gastic band surgery with medical or medicare insurance I also have scan?

Medicare pays for gastric bypass surgery only if it is deemed medically necessary.

Can you claim weight loss surgery?

For the United States, it depends on the coverage provisions of your medical benefits. Generally speaking, unless the weight loss surgery (e.g. gastric bypass, banding) is reviewed and considered medically necessary, then it is not a covered benefit.

What is a gastric bypass medicaid?

Gastric bypass is weight reduction surgery. To qualify for madicaid coverage in receiving a bypass surgery one must be considered fully disabled without surgery.

Will gastric bypass acceptable with medicaid?

Medicaid will cater to gastric bypass and will cover 70% if you are a premium member with the moderate to best coverage plan. They will not cover the IV or sedative though.

Does medicare cover gastric bypass?

Medicare coverage for a gastric bypass is very limited. They will only cover you if the bypass is recommended by your physician. If you are only looking to lose some weight then I'm afraid they wont cover you.

Does Pennsylvania Medicaid cover gastric bypass revision?

they still handle this as case by case...So even if you are told no you can still look for doctor that will fill out papers stating that it is medically necessary then yes.

Gastric Bypass Surgery Prices and Coverage?

Gastric bypass surgery prices are becoming more affordable. There may be little or no cost if the surgery is deemed medically necessary for qualified people. More insurance companies are covering gastric bypass surgery cost because of the proven benefits of the weight loss such as treating high blood pressure, diabetes, and other health conditions. Cost varies from state-to-state and insurance plan, but the cost typically varies from $15,000 to $35,000 for uncomplicated cases. Some hospitals have payment plans if the surgery is not covered by insurance.

Will Insurance Cover Gastric Bypass?

When most people decide to turn to gastric bypass surgery for weight loss, the first question the ask is whether the costs are covered by their insurance company. Insurance coverage for gastric bypass varies by insurer, with some insurers placing many conditions in place before they will approve of the procedure. If your gastric bypass surgery is being performed to prevent a potentially fatal disease such as diabetes or heart failure, insurance plans will usually cover it. Insurance coverage for gastric bypass that is more cosmetic in nature is usually more difficult to secure. Your insurer may require that you enroll in a weight loss plan first. Find out more about insurance coverage for gastric bypass from your insurer.

What is the average cost of gastric bypass surgery in the United States?

Most insurance companies have criteria for gastric bypass coverage. This might involve BMI, other medically supervised weight loss attempts, doctor recommendations. Insurance companies do not deem what is "medically necessary." Doctors do that. Insurance companies determine what they will and will not cover, and it's up to the insured to determine what plan is best for his/her needs. There are various bariatric procedures. Expect to pay $15K-$35K depending on the procedure, location and whether the surgeons have a dedicated center or require hospitalization in a general facility .

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