Medicaid and Weight Loss Surgery Cost

Jun 15, 2022

Nothing hurts more than those numbers not moving an inch, even with rigorous exercises and diet facades, when it comes to weight loss. For some people, it is more than mere few pounds of extra weight on them, to the point where their lives are at risk. In that situation, surgery comes into play. So, does medicaid cover weight loss surgery in general? Let’s find out.

Will Medicaid Pay for Your Weight Loss Surgery?

You may be at a point where surgery is the ultimate solution to save your life, but since these procedures cost an arm and leg approximately $15,000 to $ 30,000, can you count on medicaid for help?

The good news is that Medicaid does cover weight loss surgery in most cases; however, you must fit into their criteria for coverage.

Every state has different regulations in terms of coverage; therefore, it is best to discuss your case with your bariatric surgeon beforehand.

The guidelines of Medicaid coverage are not particularly set according to a single bariatric surgery; it depends on the case. Such surgeries require that you fit some set criteria for coverage.

Medicaid Coverage Criteria For Weight Loss Surgery

So, here’s a list of parameters you must fit into to qualify for Medicaid to cover your weight loss surgery. If you pass, it covers the cost of your surgery plus your visits to the surgeon.

  • Females over 13 years and males of 15 years and over are eligible for coverage.
  • BMI, or Your Body Mass Index value, must be over 35, along with at least one comorbid disease. Some examples include high blood pressure, high cholesterol, sleep apnea, or diabetes.
  • Individuals under age 21 must have a Body Mass Index (BMI) exceeding 40, along with one or more of the comorbidities above.
  • The patient must possess a printed letter from their primary care physician stating the necessity of weight loss surgery.
  • A certificate of passing mental health exam shows that the subject in question can adopt the necessary lifestyle changes to achieve weight loss.
  • A proper documentation file with details about the failure of previous standard treatments for weight loss is a must.
  • You must complete a 6-month weight loss course under the care of a physician and provide evidence that you tried the program within the 12 months before surgery.

Disqualifying Parameters

  • Steroid use for long-term.
  • Cancer
  • In case of IBD – inflammatory bowel disease, pregnancy, or chronic pancreatitis.
  • Non-compliance with medical treatments
  • Failing the mental health exam.

Process of getting Medicaid approval for weight loss surgery

You must first determine whether weight reduction surgery is funded by Medicaid in your state. You can do this by getting in touch with your neighborhood Medicaid center. Once you know that your state provides insurance for weight loss surgery, you must fulfill certain criteria to qualify for the procedure.

You must obtain a letter of recommendation to a bariatric surgeon from your primary care physician once you meet the eligibility standards. After thoroughly reviewing your medical history and physical well-being, you will be given various weight loss surgery options. In that meeting, they will also review the process’s risks and advantages with you.

If you fall right into the category for weight loss surgery, they will submit a pre-authorization request to Medicaid on your behalf. This request will include documentation of your medical history, BMI, and weight loss attempts. The Medicaid office will review the submission and decide whether to approve the surgery.

Final Note

Want to learn more about your weight loss surgery options? Get in touch with the best bariatric surgeons from Nova Bariatrics and Minimally Invasive Surgery. Dial (469) 639-0953 to connect with us or drop by our clinic(s) at 1800 FM195, Paris, TX 75460, USA, 3150 Matlock Rd # 401, Arlington, TX 76015, USA, or 1081 Kinwest Pkwy STE 110, Irving, TX 75063, USA whichever is feasible for you.

Dr. Mustafa H. Alibhai

Dr. Alibhai, a board-certified general surgeon, passionately leads Nova Bariatrics and Minimally Invasive Surgery. Formerly an Assistant Professor at McGovern Medical School, he’s a Fellow of the American College of Surgeons and the American Society of Metabolic and Bariatric Surgeons. His academic journey includes a Bachelor’s from Southern Methodist University, Medical School at UT Southwestern, and residencies at UT Southwestern. Specializing further, he completed Bariatric and Robotic Fellowships, advancing surgical techniques with a focus on patient well-being.

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