Washington State has several insurance providers that cover bariatric surgery, including Regence BlueShield of Washington, Premera Blue Cross and Kaiser Permanente. Each provider offers coverage for a variety of bariatric procedures such as laparoscopic gastric bypass, sleeve gastrectomy and adjustable gastric banding. Coverage requirements vary by provider but may include documentation of pre-authorization from the attending physician or completion of an initial visit with a registered dietician prior to being approved.
Contents:
- Qualifications for Bariatric Surgery Coverage
- Types of Bariatric Surgery Covered in Washington State
- Cost Implications for Patients Who Don’t Have Insurance Coverage
- Flexible Spending Accounts and Health Savings Accounts
- Medicaid Coverage of Bariatric Surgery
- Private Insurance Options for Bariatric Surgery
Qualifications for Bariatric Surgery Coverage
Understanding the necessary qualifications to secure insurance coverage for bariatric surgery in Washington State is crucial for anyone considering such a procedure. To start, bariatric patients must be medically documented as having a body mass index (BMI) of 40 or more. If the BMI level is lower than 40, but has caused at least one associated health issue like type 2 diabetes or hypertension, then some insurance carriers may provide coverage with further assessment.
In addition to these criteria, potential applicants are usually required to have previously tried several weight-loss approaches with unsatisfactory results. These attempts typically include following supervised diet plans and embarking on exercise regimens. Though such efforts are not essential when applying for coverage, they often demonstrate that candidates have an awareness of the risks associated with obesity and a desire to make longterm changes in lifestyle habits.
It is important that individuals who apply meet certain psychological parameters as outlined by the insurer’s guidelines. This means that undergoing mental health assessments can be part of the pre-approval process and many providers insist on candidates meeting prescribed criteria which involve showing commitment to adhere strictly to recommended postoperative dietary restrictions and demonstrating sufficient motivation levels for adopting a successful fitness regime after surgery has been completed.
Types of Bariatric Surgery Covered in Washington State
Bariatric surgery is a major form of weight-loss intervention, and understanding the different types of procedures available in Washington State can help individuals make informed decisions about their health care coverage. Generally speaking, insurance plans in Washington cover three primary forms of bariatric surgery: gastric bypass, sleeve gastrectomy and gastric banding.
Gastric bypass involves using staples to create a small pouch from the stomach which limits food intake and changes how the body absorbs nutrients from food. It’s typically considered for people with severe obesity whose BMI (Body Mass Index) exceeds 40 or 35 along with other medical complications like diabetes or hypertension. Gastric bypass is also reversible if needed in some cases.
Sleeve gastrectomy involves surgically removing up to 80 percent of an individual’s stomach, leaving behind a banana-shaped stomach that’s approximately one-tenth its original size. This procedure is usually recommended for people who suffer from morbid obesity and are unable to achieve their desired weight loss goals through diet and exercise alone. It doesn’t require any foreign devices be inserted into the body so there are fewer risks associated with this type of procedure compared to others on this list.
Gastric banding utilizes an adjustable silicone device placed around the upper portion of the patient’s stomach creating two chambers; when full, signals tell brain we’ve had enough food – resulting in improved appetite control over time as well as helping increase satiety after eating smaller portions (feeling fuller faster). While gastric banding carries greater risk than both previously mentioned surgical treatments, studies suggest it may lead to higher long term success rate at maintaining healthy body weight due to decreased hunger pangs during diets/lifestyle changes compared to other forms of bariatric surgery.
Cost Implications for Patients Who Don’t Have Insurance Coverage
If a patient in Washington State does not have insurance coverage that covers bariatric surgery, they may need to consider paying for the procedure out-of-pocket. This could be quite costly depending on the chosen surgeon and the complexity of the case.
Patients who require bariatric surgery but don’t have health insurance will need to plan ahead financially in order to cover all costs associated with the procedure. It is important to research what surgeons are available in their area and contact them directly to get an estimate of how much it might cost overall. Some surgeries could cost as much as $20,000 or more after any related fees like anesthesia or operating room fees are added in.
It may also be possible for a patient to negotiate some kind of payment plan with the hospital or clinic where their surgery will take place, so it can be paid off over time. Patients should do their due diligence before scheduling a consultation appointment by searching online for other hospitals that offer similar services and comparing prices so they can receive estimates from multiple sources.
Flexible Spending Accounts and Health Savings Accounts
Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) are two popular options for financing bariatric surgery in Washington State. The advantage of FSAs is that they let you use pre-tax income to pay out-of-pocket health care expenses, including bariatric surgery. They can be used to pay premiums as well as the deductible. On the other hand, HSAs offer tax advantages similar to those of FSAs but also allow individuals to save money in an account designated specifically for healthcare spending – such as bariatric surgery – and potentially earn interest or investment returns on it. It’s important to note that if you have a high-deductible plan, contributions to an HSA are typically tax free. Funds from these accounts can be invested into stocks or bonds over time in order to maximize potential returns on investment.
Before opting for either an FSA or an HSA, it is important for Washington residents considering bariatric surgery to consult with their financial advisors in order to understand their eligibility criteria and any applicable fees that may come along with using either type of savings vehicle when it comes time for them go under the knife. However, with proper planning, both vehicles can offer significant benefits when planning and executing bariatric surgeries in Washington State.
Medicaid Coverage of Bariatric Surgery
Medicaid is a government program providing medical coverage for those that are low-income and have limited assets, and it often covers bariatric surgery in Washington State. Depending on the individual’s financial situation, Medicaid may also provide preoperative care and post-operative care. In addition to financial support from Medicaid, many local hospitals provide free or discounted rates to those who need bariatric surgery. For individuals considering this type of surgery, these cost savings can make the procedure more feasible for them and their families.
Medicaid guidelines differ from one state to the next; however, most states require that an individual must meet certain requirements before they are eligible for coverage of any kind – including bariatric surgery. These requirements vary significantly depending on the type of service being provided and the region in which it is offered. Generally speaking, applicants must satisfy specific income limits as well as other criteria in order to qualify for benefits related to bariatric surgery through Medicaid.
In Washington State specifically, there are several programs designed to help low-income individuals receive necessary healthcare services such as bariatric surgery with minimal out-of-pocket costs associated with treatment plans developed by doctors at health facilities throughout the area. Eligible participants may also be able to take advantage of insurance offered by organizations like Amerigroup or Molina Health Care if approved by their provider network based upon personal qualifications met according to established standards determined jointly among qualifying patients, providers and relevant healthcare professionals.
Private Insurance Options for Bariatric Surgery
Considering private health insurance when it comes to financing bariatric surgery in Washington State is a good option. Most private insurers offer coverage for a range of surgical treatments, and bariatric operations may be one of them. To determine if your particular policy provides benefits for bariatric surgery, you will need to check the details of your contract or contact the company directly.
Some major companies that provide private health insurance plans in Washington state include Premera Blue Cross, Kaiser Permanente, Aetna Health Plans, Molina Healthcare Inc. And Regence BlueShield of Washington. Each has different conditions and services covered so reading up on their website can help you identify whether they cover any portion of costs associated with this type of procedure.
Asking for referrals from family or friends who have had bariatric surgery may be beneficial as well. They can share first-hand experience about what their insurer offered in terms of coverage and costs involved with the treatment so you can make an informed decision before entering into a contract with any company.
