I don’t have any health insurance right now and I want to have the gastric bypass surgery. What insurance company will pay for this? I am in Louisiana.

We receive this inquiry quite often from people all over the country. Apparently, finding an insurance company to cover this procedure is no easy task. We do not maintain a database of all of the covered benefits offered by the health insurance plans in various states, so we are not able to answer your question definitively. However, we can perhaps help you understand why you are running into problems finding an insurance company that will pay for gastric bypass surgery.

Firstly, even if an insurance company does cover gastric bypass surgery, their representatives or plan brochures are not likely to say “We cover gastric bypass surgery.” This is because there may be many variables that determine if they will cover this procedure. Primarily, it must be deemed “medically necessary” for you to receive pre-authorization for treatment, if the benefit is offered at all. Most physicians will hesitate giving you this classification unless you have exhausted, or are unable, to use alternative methods to loose weight, such as diet and exercise.

Secondly, in most states, including Louisiana, individual health insurance requires you to complete a health insurance application that will determine your eligibility. Part of this application includes questions to determine your health status, including your weight. Most insurance companies will not offer coverage to individuals that exceed a maximum weight for their height. The insurance companies consider obesity a greater immediate health risk than smoking and are concerned about the claims that will be submitted by persons in this classification. So, if your weight exceeds the maximum allowable by insurance companies, you may not be eligible for coverage even if you do find a health insurance company that covers gastric bypass surgery.

If you have a group health plan available to you from an employer, or the employer of a spouse, this may be the best option for you to consider. Louisiana also has a high-risk health pool, but you would need to contact them about covering this benefit and any waiting periods.

2 Comments

1. yes i was wondering the same i am laid off from my job i have health issues and i am in need of this surgery but i have no insurance. i have high blood pressure,diabetes,and sarcoid the steroids have made me gain 40lbs. i need this surgery bad please help

   Comment by keisha — April 16, 2009 @ 6:21 am

2. My PPO insurance has refused to pay for the surgery. I am new to this kind of thing but about to get the surgery and my PPO insurance company sent a letter to the doctor saying very clearly that they did not want to pay for the surgery and that they had no intention of doing so in the future. I am 52 years old and 287 lbs. by the way, so I know I need it. I have many side effects from obesity such as back problems, sleep apnea and kidney problems. I have been trying to lose weight on my own many times but I need the bypass. I am really worried as this could turn into a very serious situation in the future. Is there anything I can do to make the insurance company pay? Or is there some sort of government program or insurance that can help me out. It would be good for others if there was a list of insurance companies that would pay for gastric bypass.

   Comment by Bobby — June 4, 2009 @ 12:34 pm

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