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Can you be denied coverage for gastric bypass if it is medically necessary?


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Answered 2009-09-22 05:56:04

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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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.

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).

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.

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.

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

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

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.

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.

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.

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.

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.

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 .

Gastric bypass diet is a set of modified meal plans intended for gastric bypass patients.

Gastric Bypass Surgery is an elective surgery that morbidly obese patients receive in order to resize the stomach pouch and in turn cause them to consume less food. This type of surgery is extremely costly and patients often require help from their health insurance company. Patients who are on Medicare are sometimes granted coverage for the surgery is they meet certain criteria. Medicare patients must submit a form from their psychician stating that the surgery is medically necessary or that the surgery is necessary to correct an illness that was caused by the patient's obesity.

will you feel if your gastric bypass opens?

it depends on the state you are living in California medi-cal says no but if you join health net they cover it with your doctors recommendations

"After getting your goal bladder removed do to gastric bypass,What else I'm I suppose to expect, do to gastric bypass?

Gastric bypass is an option for people with diabetes. Gastric bypass can even help in diabetes treatment.

If you have had gastric bypass surgery and become pregnant, your doctor will closely monitor you. Detailed information about gastric bypass surgery and pregnancy is available at:

The cost gastric bypass surgery varies by procedure, geographic location, the surgeon and hospital, as well as if the procedure is done inpatient or outpatient. Gastric bypass surgery generally ranges from $18,000 to $35,000, while some gastric banding surgeries can be as little as $16,000 to $25,000. The physician will need to send the insurance company information showing the procedure is medically necessary so that it is covered, either in full or in part. Consult the insurance company as well as the facilities that are being considered to get an overview of the cost.

Medicare is a type of insurance that may pay for a gastric bypass. It is not the name of a specific bypass procedure. The gastric bypass can improve your health if you have aggravated obesity.

You can find information on the gastric bypass revision at It's generally an option for someone who had an issue with their gastric bypass.

It is important to look into the risks and benefits of gastric bypass surgery, before having the proceedure. The websites online that have information on gastric bypass surgery include:

You can find information about dieting after gastric bypass surgery here: and

You can find out information about the gastric band versus the gastric bypass surgery on or

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