How long does it take medicaid to approve weight loss surgery 2022

According to the Centers for Disease Control and Prevention (CDC), nearly 40% of US adults are obese. Obesity increases the chance of major health risks and may significantly decrease a person’s quality of life. Thus, shortening the lifespan. When fighting obesity, weight loss surgery – such as bariatric surgery – is one of the most efficient approaches.

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If you are a Medicare beneficiary hoping to receive bariatric surgery, you could receive coverage through your Medicare plan. Medicare coverage for bariatric weight loss surgery is available for beneficiaries who meet specific criteria. While not all bariatric weight loss surgeries receive coverage, several options are available for those with Medicare.

Does Medicare Cover Bariatric Weight Loss Surgery?

The demand for Medicare coverage of bariatric weight loss surgery is steadily growing as the obesity rate of Americans is on the rise. After meeting various requirements and gaining approval from a licensed physician, Medicare coverage includes different bariatric weight loss surgeries to treat obesity and related health conditions.

Although Medicare pays for bariatric procedures, the program decides denial or approval of benefits on a case-by-case basis. To be considered for approval, the bariatric surgery must first be approved by the FDA. However, even after a Medicare beneficiary meets the requirements for bariatric surgery, Medicare coverage is still at the discretion of their doctor and Medicare.

Not all situations in life are the same. Unfortunately, this means coverage may vary from person to person. However, bariatric surgery is often deemed medically necessary because many conditions stem from morbid obesity.

Types of Bariatric Weight Loss Surgeries Covered By Medicare

Although Medicare covers several bariatric weight loss surgeries, it doen’t cover all surgery types. Following is a list of weight-loss surgeries that receive coverage from Medicare:

• Gastric Bypass
• Sleeve Gastrectomy
• Duodenal Switch
• Lap-Band Surgery

Outside of this list of procedures, Medicare coverage for weight loss surgery is limited and may not be available.

Gastric Bypass

Gastric Bypass is a medical procedure that splits the stomach into small portions to restrict caloric intake. After an obesity screening with a BMI test and counseling Medicare may cover gastric bypass surgery. However, you must meet the criteria for morbid obesity and satisfy any deductible costs.

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Sleeve Gastrectomy

Medicare covers sleeve gastrectomy surgery when your doctor deems it medically necessary and you meet the bariatric requirements.

More commonly known as gastric sleeve surgery, this procedure removes and separates about 85% of the stomach. Then, the remainder gets molded into a tubular shape that can’t contain much food or liquid.

Patients lose an average of 65% of extra weight after gastric sleeve surgery, which may be why it is one of the fastest-growing bariatric surgeries.

Duodenal Switch

The duodenal switch is a newer surgery option available with Medicare coverage. Like the gastric sleeve option, DS removes a large portion of the stomach.

Medicare covers duodenal switch surgery, although it may be challenging to find a surgeon who will perform the procedure. Many surgeons are not as familiar with this surgery, making it more challenging to find the right doctor.

Lap-Band

Lap-Band surgery is a type of gastric bypass that splits your stomach into an upper and lower section. Under the right conditions, Medicare will cover lap band surgeries. The cost varies depending on several factors. Talk to your doctor and ask how much surgery may cost so you can plan for out-of-pocket expenses.

Medicare Requirements for Bariatric Surgery Coverage

• One or more obesity-related health condition
• Medical documents of obesity for more than five years and letter of recommendation from physician
• Ruled out medical disease-causing obesity
• BMI of 35 or greater
• Documented participation in medically supervised weight loss program
• Passed a psychological exam

To be considered a candidate for bariatric weight loss surgery, you must meet all the above requirements. Even if you meet each requirement, Medicare is not required to approve your surgery. Each approval is on a case-by-case basis.

How Long Does It Take Medicare to Approve Bariatric Surgery?

Bariatric weight loss surgery approval by Medicare can be a complicated process. From the first appointment to medical clearance, Medicare may take three to four months to approve the surgery. However, this timeframe may vary depending on health conditions and severity.

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Medicare Comorbidities for Bariatric Surgery

Comorbidities are health conditions that relate to another health problem. Sometimes, this means one health issue causes another problem. In the case of bariatric surgery, comorbidities refer to any condition derived as a direct result of morbid obesity. Medicare lists major bariatric surgery approved comorbidities as: type 2 diabetes, sleep apnea, hypertension, joint or back pain, soft tissue infections, and more.

If you are morbidly obese and are not experiencing any of the diagnoses above, you may still qualify for bariatric surgery. However, you must prove comorbidity due to obesity.

Average Cost of Bariatric Weight Loss Surgery With Medicare

In the United States, the average cost of bariatric weight loss surgery can be as much as $25,000-$30,000. With Medicare Part A and Part B, those who meet the eligibility requirements and are accepted for coverage will be responsible for the Medicare Part A and Part B deductibles, Medicare Part B 20% coinsurance, and any coinsurance or deductible payments for Medicare Part D.

Medicare Part A helps cover the inpatient hospital expenses. However, if your surgery is an outpatient procedure, Medicare Part B helps pay 80% of doctor services and supplies. Then, Medicare Part D will cover any prescription medications that your doctor prescribes after surgery.

A Medicare Supplement plan would cover most, if not all, of your out-of-pocket expenses after Original Medicare pays. On the other hand, if you receive coverage from a Medicare Advantage plan, you may need to go through more extensive pre-requisites. This is because your coverage will differ from Original Medicare.

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How to Get Help with Medicare Coverage for Bariatric Weight Loss Surgeries

At MedicareFAQ, we understand how seniors living on a fixed income may feel bariatric surgery is financially out of the question. But, you still have options to explore!

We can help find a Medicare Supplement plan tailored to your health care needs. Just give us a call at the number above to speak to one of our licensed agents today, free and with no obligation.

Our online rate form is easy to fill out for additional information on the plans available in your area. We're here to build a relationship with our clients, who trust us with their health care coverage.

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

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