Many patients are surprised to learn their insurance may cover weight loss surgery. Others find their plan excludes it. Coverage depends on your specific plan, not just your insurance company, so the most reliable answer comes from checking your benefits. We do that for you, for free.
Is coverage required in Texas?
Texas does not require every health plan to cover weight loss surgery. Some employer and individual plans include it, and others exclude it. Two plans from the same insurance company can have different rules.
What plans that cover it usually require
- BMI: usually 40 or more, or 35 or more with a weight-related condition such as type 2 diabetes, high blood pressure or sleep apnea.
- A documented weight loss history: some plans require a medically supervised diet program, often for 3 to 6 months, before surgery.
- Evaluations: a psychological evaluation and a nutrition consultation are commonly required.
- Prior authorization: your surgeon's office submits your records for approval before surgery is scheduled.
Medicare and Medicaid
Medicare covers certain bariatric procedures, including gastric bypass and sleeve gastrectomy, for patients with a BMI of 35 or more who have at least one obesity-related condition and have tried medical treatment for obesity without success.
Texas Medicaid can cover bariatric surgery for patients who meet its medical criteria, with prior authorization.
Houston Surgical Weight Loss accepts most major commercial plans, Medicare and Medicaid.
If your plan doesn't cover it
Self-pay is often simpler and faster than people expect. Our self-pay gastric sleeve starts at $6,999, with surgeon and nutritionist consultations for 1 year included, and is available from a BMI of 30. Financing is available through Cherry and CareCredit.
The easiest way to find out
Send us your insurance details and we'll verify your coverage for free, including what your plan requires before surgery. Call 281-653-6544 or request a consultation.
Related reading
Sources
- Centers for Medicare & Medicaid Services, National Coverage Determination 100.1: Bariatric Surgery for Treatment of Co-Morbid Conditions Related to Morbid Obesity.
- Texas Medicaid & Healthcare Partnership (TMHP), Texas Medicaid Provider Procedures Manual, bariatric surgery services.
- Houston Surgical Weight Loss Self-Pay and Insurance pages.
This article is general information, not medical advice. Talk with your doctor about what is right for you.