Bariatic Surgery Coverage in States NOT Required to Include It Under the Affordable Care Act

by Lynn
(South Carolina)


We are thinking of signing up for the Affordable Care Act Gold Program some time in the future. We currently have BC/BS, but it will not pay for bariatric services. We’ve had this insurance for at least 10 years.

I noticed that my state is NOT on the list for Affordable Care Act bariatric services. Is there any way around this if the surgery is medically necessary or if we have the surgery in a different state?


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Response to "Bariatic Surgery Coverage in States NOT Required to Include It Under the Affordable Care Act"

by: Jeff

Hi Lynn,

Unfortunately, if your insurance provider is based in a state that does not mandate bariatric surgery coverage, you will be unlikely get them to approve the surgery whether or not it is medically necessary, even if you have the surgery in another state.

There are many bariatric surgery and other professionals who are working to change the Affordable Care Act policies regarding weight loss surgery since it has the potential to improve the physical and mental health of so many people AND because it makes long-term financial sense (the return on investment is well worth it; people who have bariatric surgery pay much less in health care costs over time than those who don't).

For example, see this article called "States Variations in the Provision of Bariatric Surgery Under Affordable Care Act Exchanges."

If you want insurance to pay, your only current options are:

1) For you or your spouse/partner to start working for a company with MORE than 50 full-time employees with insurance coverage that includes bariatric surgery

2) If you qualify, sign up for Medicare or Medicaid since both programs include weight loss surgery (some limitations apply)

3) Move to a state that mandates weight loss surgery coverage and sign up for an Affordable Care Act policy upon arrival

Sorry for the bad news.

For what it's worth, as a self-pay patient there are several options available that can make the surgery more affordable.

For more information, see this page about Obamacare Weight Loss Surgery.

Take care, and good luck.


Other Related Pages:
- Bariatric Surgery Insurance: Complete Patient Guide
- Weight Loss Surgery Insurance Secrets

Insurance requirements

by: Elizabeth

My state is listed as one that REQUIRES insurance companies in many states to include bariatric surgery in ALL Individual, Family and Small Group plans (insurance plans for companies with 50 or fewer full-time employees). My insurance says they don’t. How can I get them to change that?

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Join in and write your own page! It's easy to do. How? Simply click here to return to Obamacare Weight Loss Surgery Coverage by State.

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