Orbera insurance

Orbera insurance refers to health insurance coverage for the Orbera intragastric balloon weight loss procedure. Most US health insurers, such as Aetna and UnitedHealthcare, classify Orbera as elective and label it investigational or experimental.

Insurers like Blue Cross Blue Shield typically deny claims for Orbera because the FDA approved it in 2015 but lacks long-term outcome data. Medicare does not cover Orbera since CMS excludes most bariatric devices except gastric bypass and sleeve gastrectomy.

Medicaid programs in states including California and Texas exclude intragastric balloons from covered bariatric services, as reported by Your Insurance Info. Out-of-pocket costs for Orbera average $6,000 to $7,000 per procedure according to RealSelf user-reported payments.

Some clinics offer financing plans through lenders like CareCredit but these are not insurance products. Prior authorization requests for Orbera almost always result in denial letters citing insufficient evidence of sustained effectiveness compared to covered alternatives.

Appeals processes rarely succeed unless patients demonstrate severe comorbidities unresponsive to other treatments with supporting medical documentation.