Does medicare cover bariatric surgery? Do they cover gastric sleeve surgery? Is there a co-pay?
To qualify for coverage for weight loss surgery, your policy must specifically include coverage. Not all plans from Kaiser include bariatric surgery. To find out if your policy provides coverage, contact Kaiser directly.
Kaiser Permanente does cover weight loss surgery if the patient meets a variety of requirements. Surgery is seen as a tool for severely obese who cannot lose weight the traditional way. Kaiser covers bariatric surgery in most cases if the patient:
- Has a body mass index of 40 or greater OR
- Has a body mass index of 35 or greater with at least one comorbidity (Comorbidities can include high cholesterol, high blood pressure,
obstructive sleep apnea, Type II Diabetes or arthritis, to name a few.) - Over the age of 18
- Completed a medically-supervised program within the last two years (with proven medical documentation)
- Morbidly obese of the last 3 of 5 years, which was documented by a physician.
Successfully completed a mental health evaluation. Patient has no issues that will keep them from sticking to their new diet and lifestyle changes.
Weight Loss Surgery Types Covered by Kaiser Permanente
The insurer covers most surgeries including:
- Lap gastric band (Realize band and Lap-Band)
- Gastric sleeve
- Gastric bypass
- Duodenal switch surgery
Procedures not covered include trans-oral stapling procedures, gastric plication with or without a gastric band and mini-gastric bypasses.
Other Things to Note Regarding Kaiser Coverage
Lap band fills covered if the original procedure was covered by Kaiser. Kaiser does require using Centers of Excellence so you must stay in-house and have your process accordingly for full coverage. Make sure that your facility is covered so that you don’t have any unnecessary costs post-op.
