Gastric balloon
A gastric balloon is a non-surgical, temporary weight loss device placed in the stomach to limit food intake and promote satiety. Most insurance plans, including examples like Aetna and Cigna, do not cover gastric balloon procedures as they classify them as elective or investigational.
Some flexible spending accounts (FSAs) and health savings accounts (HSAs), such as those from Fidelity or Optum Bank, may reimburse gastric balloon costs if prescribed for obesity treatment. Out-of-pocket expenses for gastric balloon placement in the US typically range from $6,000 to $9,000 according to Bariatric Surgery Source data.
The majority of insurers require proof of medical necessity before considering exceptions for coverage of bariatric devices like gastric balloons. Medicare does not cover intragastric balloons as of 2024, per CMS guidelines.
Most employers’ group health policies specifically list intragastric balloons among excluded obesity treatments, based on policy documents from UnitedHealthcare and Anthem. Removal costs for gastric balloons are usually billed separately and can add $1,500–$2,000 according to RealSelf reports.
Insurance appeals for denied gastric balloon claims rarely succeed unless supported by clinical documentation of failed previous obesity interventions. Some clinics offer financing options through companies like CareCredit or Prosper Healthcare Lending to help patients manage upfront costs, based on information from YourInsurance.info.
Most state Medicaid programs explicitly exclude coverage for intragastric balloon therapy according to Kaiser Family Foundation surveys.
Does insurance pay for a gastric balloon?
In most cases, health insurance will not pay for a gastric balloon. Generally, gastric balloons are considered to be an elective or cosmetic procedure and are thus excluded from coverage. Some insurance plans may provide limited coverage for this procedure if medically necessary, but it is best to check with the insurance provider directly to…
Does insurance cover a gastric balloon?
Yes, insurance typically covers a gastric balloon for those who meet the necessary criteria. Coverage varies depending on an individual’s health plan and overall health status, so it is best to check with your insurer regarding specific coverage details. Generally speaking, most major insurance companies provide coverage for gastric balloons as long as it is…
Why isn’t the gastric balloon covered by insurance?
The gastric balloon is not typically covered by insurance because it is considered a non-essential, elective procedure. The device itself does not cure or treat any medical condition and thus there is no need for insurance to cover the cost of the procedure or device. Since the risks of insertion and removal are often greater…
Is the gastric balloon covered by insurance?
Yes, the gastric balloon may be covered by some insurance providers. Insurance policies vary from provider to provider, so it is important to check with your individual insurance policy in order to determine coverage and any out of pocket costs associated with the procedure. Co-pays or co-insurance amounts might also apply, depending on the plan’s…
See also Gastric balloon insurance.