Does Insurance Cover Bariatric Surgery?
Quick Answer: Many Insurance Plans cover Bariatric Surgery when it is medically necessary and you meet plan criteria. The next question is usually: “How much is covered, and what do I need to do to get approved?”
Important: Coverage and requirements vary by Plan, Employer, Network, and State. This guide helps you understand the process, then verify your exact benefits before you start.
What Is Usually Included in Bariatric Surgery Insurance Coverage
People hear “it’s covered” and assume everything is paid for. In reality, coverage usually has two layers:
- Benefits: Your plan includes Bariatric Surgery as a covered service.
- Approval: You meet the plan’s criteria and your Prior Authorization is approved.
Coverage varies, but many plans commonly consider these parts of care (when medically necessary and properly authorized):
At Tampa Weight Loss Institute, we accept Medicare and Medicaid, and we also work with many Commercial Plans. We verify benefits up front and guide you through the checklist.
Coverage by Plan Type: for Common Insurers
These are the plan-specific questions people ask most often. We keep the answers short here so you can move on quickly, then we explain the approval process in detail later. (Plan participation and requirements can vary by Employer and State.)
Blue Cross Blue Shield
- Coverage is plan-specific. Many BCBS plans cover Bariatric Surgery, but some Employer Plans exclude it.
- Requirements typically include eligibility criteria, documentation, and Prior Authorization.
- Your cost depends on your Deductible and Coinsurance, plus whether the Surgeon and Facility are In-Network.
- If you are not sure, we can verify your benefits and tell you the exact checklist your plan requires.
Eligibility Criteria
BMI ≥ 40 (Class III Obesity), or
BMI ≥ 35 with at least one significant Obesity-Related Comorbidity, commonly:
Type 2 Diabetes
Hypertension
Obstructive Sleep Apnoea
Dyslipidaemia
Nonalcoholic Fatty Liver Disease / NASH
Severe Osteoarthritis with functional limitation
Failure of Non-Surgical Weight Loss (Medical Management) over time (Diet/Exercise/Medication Attempts), when clinically appropriate
Aetna
- Aetna coverage varies by plan and Employer. Some plans cover Bariatric Surgery when medically necessary; others may have exclusions.
- “Policy” usually means the pre-op checklist and Prior Authorization rules (what evaluations and documentation Aetna wants to see).
- Your out-of-pocket cost depends on your plan design and network status of your Surgeon and Facility.
- We accept many Aetna plans and can confirm your exact benefits before you begin.
Eligibility Criteria
- BMI ≥ 40, or
- BMI ≥ 35 with at least one serious Comorbidity (commonly Type 2 Diabetes, Sleep Apnoea, Hypertension, NASH, etc.)
- Clinically significant Health Risk attributable to Obesity (Medical Necessity)
- Failure of conservative Medical Management (non-surgical Weight Loss), when appropriate
TRICARE
- TRICARE coverage depends on eligibility and the correct referral/authorization pathway.
- TRICARE Prime can have stricter referral and network rules compared to other TRICARE options.
- If you are using TRICARE, verifying the referral, facility eligibility, and prior authorization process early prevents delays.
Eligibility Criteria
BMI ≥ 40, or
BMI ≥ 35 with significant Comorbidity (commonly Type 2 Diabetes, Hypertension, Sleep Apnoea, etc.)
Obesity causing significant Medical Risk where Surgery is medically justified
Prior failure of non-surgical Weight Loss (Medical Management), when appropriate
UnitedHealthcare
- UnitedHealthcare Coverage is plan-specific. Many UnitedHealthcare Plans cover Bariatric Surgery when it is medically necessary, but some Employer Plans exclude Bariatric benefits entirely.
- Requirements typically include an eligibility checklist, documented Weight Loss history, and Prior Authorization before Surgery can be scheduled.
- Your cost depends on your Deductible, Coinsurance, and Out-of-Pocket Maximum, plus whether the Surgeon, Facility, and Anesthesia are In-Network.
- If you are not sure what your specific Plan covers, we can verify your benefits and confirm the exact checklist your UnitedHealthcare Plan requires before you begin.
Eligibility Criteria
BMI ≥ 40, or
BMI ≥ 35 with Obesity-Related Comorbidity (same usual suspects)
Medical Necessity based on Health Risk + comorbidity burden
Inadequate response to Non-Surgical Weight Loss (Medical Management), when appropriate
Cigna
- Cigna Coverage varies by Plan and Employer. Many Cigna Plans cover Bariatric Surgery for qualifying patients, but some Employer Plans have exclusions or additional requirements.
- Requirements often include medical eligibility criteria, documentation of previous Weight Loss efforts, and Prior Authorization with supporting records.
- Your out-of-pocket cost depends on your Plan design (Deductible, Coinsurance, Copays) and whether your Surgeon and Facility are In-Network.
- We accept many Cigna Plans and can verify your benefits early, so you know what is required and what your expected costs may look like before starting the process.
Eligibility Criteria
BMI ≥ 40, or
BMI ≥ 35 with clinically significant Comorbidity (same core list: Diabetes, Hypertension, Sleep Apnoea, etc.)
Obesity Duration + Medical Risk sufficient to justify Surgery (Medical Necessity)
Failure of Non-Surgical Therapy (Medical Weight Loss), when medically appropriate
Free Surgery: Employer Based Coverage
Some Employer Health Plans include Surgery Benefit Programs like Lantern and Transcarent that can make Bariatric Surgery $0 for eligible members. If your Employer offers one of these Programs, you may be able to check eligibility upfront, see what’s included, and get guided through the right Provider and Facility pathway without the usual Insurance back-and-forth.
What to expect: a quick qualification check, confirmation of eligibility and coverage, and clear next steps if you qualify. If you are not sure whether your Employer offers Lantern or Transcarent, we can help you identify it.
Frequently Asked Questions
How long does Insurance take to approve Bariatric Surgery?
Does Insurance cover Bariatric Surgery for everyone?
What if my plan excludes Bariatric Surgery?
Does Insurance cover Revision Bariatric Surgery?
Does Insurance cover Skin Removal after major weight loss?
Next Step: Get Your Benefits Verified
If you are in Tampa or Florida, Tampa Weight Loss Institute can verify your coverage and tell you exactly what your plan requires before you commit time and energy.
- We confirm whether Bariatric Surgery is covered under your plan (and whether there are Employer exclusions).
- We confirm network status for Surgeon and Facility.
- We give you a plan-specific checklist and help you prepare for Prior Authorization.
- We provide a clear timeline and next steps based on your situation.