Gastric Sleeve Insurance Coverage Requirements

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Gastric sleeve insurance coverage in the U.S. varies by insurance policy. Your insurance will cover gastric sleeve if your specific policy includes weight loss surgery and you have:

  • Completed a medically supervised diet program
  • A body mass index (BMI) over 35 with health problems or over 40 without health problems

Gastric sleeve cost with insurance is about $3,500, depending on your policy. The cost of gastric sleeve surgery without insurance is $19,000, on average, but varies widely by state and surgeon.

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Gastric Sleeve Insurance Coverage

Does insurance cover gastric sleeve surgery?

  • Yes, for individual policies, family policies, and small group policies located in Obamacare states
  • Yes, for large group policies that choose to include it
  • Yes, for Medicare and Medicaid
  • No, for individual policies, family policies, and small group policies that are not located in Obamacare states
  • No, for large group policies that choose to exclude it

Click your plan type below for more information.

Individual or Family Insurance

Due to the passage of the Affordable Care Act (Obamacare), insurance companies in 23 states are REQUIRED to cover weight loss surgery for all Individual Plans, Family Plans and Small Group Plans (employers with fewer than 50 full-time employees). See the adjacent box for an updated list of Affordable Care Act weight loss surgery states.

Obamacare Weight Loss Surgery States (for Individual, Family & Small Group Plans)

  • Arizona
  • California
  • Delaware
  • Hawaii
  • Illinois
  • Iowa
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Oklahoma
  • Rhode Island
  • South Dakota
  • Vermont
  • West Virginia
  • Wyoming

To confirm your gastric sleeve insurance coverage, you have a couple of options:

  • Option 1 (recommended): Your local surgeon will contact your insurance company to confirm your benefits for free (even if you don’t move forward with surgery). Their office will be very familiar with your insurance company’s requirements and approval process, so it’s usually a good idea to let them do the leg work for you. Click here to find a local surgeon.
  • Option 2: Contact your insurance company yourself and/or check your Summary Plan Description (SPD). Click here for the full list of United States insurance companies, contact information and gastric sleeve insurance coverage requirements.

If you find out that weight loss surgery is not covered, you still have several options for financing bariatric surgery to make treatment more affordable and to potentially reduce your out of pocket expenses.

For more information about Bariatric Surgery and the Affordable Care Act, see our Obamacare Weight Loss Surgery Page.

Through Work: Small Group (50 or fewer full-time employees)

Weight loss surgery insurance coverage guidelines for Small Group (50 or fewer full time employees) are the same as for Individual/Family Plans. Click here to jump up to that section.

To confirm your Small Group gastric sleeve insurance coverage, you have a three options:

  • Option 1 (recommended): Your local surgeon will contact your insurance company to determine your coverage details for no charge (even if you decide not to have surgery). Their office has been through the approval process with your insurance company many times, so let them work on your behalf to make the process go as smoothly as possible. Click here to find a local surgeon.
  • Option 2: Ask your Human Resources (HR) Department whether or not weight loss surgery is an included benefit under your plan.
  • Option 3: Contact your insurance company yourself and/or check your Summary Plan Description (SPD). Click here for the full list of United States insurance companies, contact information and gastric sleeve insurance coverage criteria.

If you have short term disability insurance through your employer, also see our section on Disability Insurance. You may be able to receive portion of your monthly salary while you’re having and recovering from surgery.

Through Work: Large Group (More than 50 full-time employees)

If you get your insurance through your work and your employer has 51 or more full time employees, it is completely up to your company to decide whether or not to cover weight loss surgery.

To confirm your gastric sleeve insurance coverage, you have a three options:

  • Option 1 (recommended): Your local surgeon will contact your insurance company to confirm your benefits for free. Their office will be very familiar with your insurance company’s requirements and approval process, so it’s usually a good idea to let them do the leg work for you. Click here to find a local surgeon.
  • Option 2: Ask your Human Resources (HR) Department whether or not weight loss surgery is an included benefit under your plan.
  • Option 3: Contact your insurance company yourself and/or check your Summary Plan Description (SPD). Click here for the full list of United States insurance companies, contact information and gastric sleeve insurance policy details.

If you find out that gastric sleeve insurance is NOT included under your plan, you may want to head over to our Weight Loss Surgery Insurance Secrets page to learn how you may be able to get your company to add the coverage.

If you have short term disability insurance through your employer, you may be able to receive portion of your monthly salary while you’re having and recovering from surgery. See our Short Term Disability section for more information.

Medicare/Medicaid

Medicare and Medicaid BOTH cover bariatric surgery as long as you meet their qualification guidelines:

Medicaid Coverage & Bariatric Surgeons

Many surgeons do not accept Medicaid due to lower reimbursement levels (they are unable to cover their costs with the lower fees that Medicaid is allowed to pay).

Contact your local surgeon to confirm whether or not they will accept your Medicaid insurance. If they don’t, ask for a referral to a surgeon who does.

  1. A body mass index (BMI) over 35
  2. At least one co-morbidity (health problem) related to obesity
  3. Must have documentation in your medical records confirming that previous attempts at medical treatment for obesity have been unsuccessful

If you meet each of the above criteria, Medicare and Medicaid will cover the following procedures:

To get approved, you’ll need to be referred by your primary care physician or other attending doctor (probably not just a self-referral to a bariatric surgeon). Your surgeon will also need to be in The Centers for Medicare and Medicaid Services (CMS) directory.

If you have Medicare Advantage, you’ll need to verify that your chosen surgical team and their hospital are in your insurance company’s network. Contact your insurance company directly to find out (click here for a full list of insurance companies and contact info).

See our Medicaid/Medicare Bariatric Surgery page for more information.

Gastric Sleeve Insurance Coverage

Is gastric sleeve covered by your insurance policy? Yes, as long as bariatric surgery is a covered benefit under your plan.

The chart below includes the following information for every insurance company in the United States:

  • Link to local surgeon directory: Most surgeons will contact your insurance company for you for free to confirm your gastric sleeve insurance coverage (they’ll usually do this regardless of whether you’ve decided to move forward with surgery). Their office will likely be very experienced in dealing with the complicated nuances of getting surgery approved by your insurance company, so we highly recommend working through them instead of trying to figure things out on your own. Click here to contact a local surgeon to get the process started.
  • Link to weight loss surgery insurance coverage policy: the presence (or lack of) a link to your insurance company’s policy does NOT confirm whether or not you have coverage. To figure out if your plan includes gastric sleeve insurance, see the Coverage by Plan Type and State section above.
  • Link to insurance company contact info: We’ve found your insurance company’s contact info for you so you don’t have to go digging for it.

Click the letter that your insurance company’s name begins with or scroll through the table to find your insurance company…

Insurance Companygastric sleeve insurance Coverage PolicyFind Local Surgeon (Will Check Insurance for Free)Insurance Company Contact Info
1199SEIUNo weight loss surgery coverage criteria availableAsk Local Surgeon to Check Your 1199SEIU Benefits for Free
AetnaAetna Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Aetna Benefits for Free
AltiusNo weight loss surgery coverage criteria availableAsk Local Surgeon to Check Your Altius Benefits for Free
American Medical SecurityNo weight loss surgery coverage criteria availableAsk Local Surgeon to Check Your American Medical Security Benefits for Free
AmeriHealthAmeriHealth Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your AmeriHealth Benefits for Free
Anthem Blue Cross and/or Blue ShieldAnthem Blue Cross Blue Shield Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Anthem BCBS Benefits for FreeContact Anthem BCBS Directly
Arches Health PlanNo weight loss surgery coverage criteria availableAsk Local Surgeon to Check Your Arches Health Plan Benefits for Free
Arise Health PlanNo weight loss surgery coverage criteria availableAsk Local Surgeon to Check Your Arise Health Plan Benefits for Free
Asuris Northwest HealthAsuris Northwest Health Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Asuris Northwest Health Benefits for Free
Blue Cross and/or Blue Shield (Alabama)Blue Cross Blue Shield Alabama Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Blue Cross Blue Shield (Alabama) Benefits for FreeAsk Local Surgeon to Check Your Blue Cross Blue Shield (Alabama) Benefits for Free
Blue Cross and/or Blue Shield (Alabama)Blue Cross Blue Shield Arizona Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Blue Cross and/or Blue Shield (Arizona) Benefits for FreeAsk Local Surgeon to Check Your Blue Cross and/or Blue Shield (Arizona) Benefits for Free
Blue Cross and/or Blue Shield (Arkansas)Blue Cross Blue Shield Arkansas Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Blue Cross Blue Shield Arkansas Benefits for Free
Blue Cross and/or Blue Shield (California)Blue Shield California Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Blue Shield California Benefits for Free
Blue Cross and/or Blue Shield (Florida)Blue Cross Blue Shield Florida Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Blue Cross Blue Shield Florida Benefits for Free
Blue Cross and/or Blue Shield (Georgia)Blue Cross Blue Shield Georgia Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Blue Cross Blue Shield Georgia Benefits for FreeContact Blue Cross and/or Blue Shield (Georgia) Directly
Blue Cross and/or Blue Shield (Hawaii)Blue Cross and/or Blue Shield (Hawaii) Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Blue Cross and/or Blue Shield (Hawaii) Benefits for Free
Blue Cross and/or Blue Shield (Idaho)Blue Cross and/or Blue Shield (Idaho) Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Blue Cross and/or Blue Shield (Idaho) Benefits for Free
Blue Cross and/or Blue Shield (Illinois)Blue Cross Blue Shield Illinois Weight Loss Surgery Coverage CriteriaBlue Cross Blue Shield Illinois Weight Loss Surgery Coverage Criteria
Blue Cross and/or Blue Shield (Kansas City)Blue Cross Blue Shield Kansas City Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Blue Cross Blue Shield Kansas City Benefits for Free
Blue Cross and/or Blue Shield (Kansas)No weight loss surgery coverage criteria availableAsk Local Surgeon to Check Your Blue Cross and/or Blue Shield (Kansas) Benefits for Free
Blue Cross and/or Blue Shield (Louisiana HMO)Blue Cross Louisiana HMO gastric sleeve insurance coverage requirementsAsk Local Surgeon to Check Your Blue Cross and/or Blue Shield (Louisiana HMO) Benefits for Free
Blue Cross and/or Blue Shield (Louisiana NON-HMO)No weight loss surgery coverage criteria availableAsk Local Surgeon to Check Your Blue Cross and/or Blue Shield (Louisiana) Benefits for Free
Blue Cross and/or Blue Shield (Massachusetts)Blue Cross and/or Blue Shield Massachusetts Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Blue Cross Blue Shield Massachusetts Benefits for Free
Blue Cross and/or Blue Shield (Michigan)Blue Cross Blue Shield Michigan Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Blue Cross Blue Shield Michigan Benefits for Free
Blue Cross and/or Blue Shield (Minnesota)Blue Cross and/or Blue Shield (Minnesota) Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Blue Cross and/or Blue Shield (Minnesota) Benefits for Free
Blue Cross and/or Blue Shield (Mississippi)Blue Cross and/or Blue Shield (Mississippi) Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Blue Cross and/or Blue Shield (Mississippi) Benefits for FreeContact Blue Cross and/or Blue Shield (Mississippi) Directly
Blue Cross and/or Blue Shield (Montana)Blue Cross and/or Blue Shield (Montana) Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Blue Cross and/or Blue Shield (Montana) Benefits for Free
Blue Cross and/or Blue Shield (Nebraska)Blue Cross and/or Blue Shield (Nebraska) Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Blue Cross and/or Blue Shield (Nebraska) Benefits for Free
Blue Cross and/or Blue Shield (New Mexico)Blue Cross and/or Blue Shield (New Mexico) Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Blue Cross and/or Blue Shield (New Mexico) Benefits for Free
Blue Cross and/or Blue Shield (New York – Northeastern)BlueShield of Northeastern New York Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your BlueShield of Northeastern New York Benefits for FreeContact BlueShield of Northeastern New York) Directly
Blue Cross and/or Blue Shield (New York – Western)BlueCross Blue Shield of Western New York Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your BlueCross Blue Shield of Western New York Benefits for FreeContact BlueCross Blue Shield of Western New York Directly
Blue Cross and/or Blue Shield (North Carolina)Blue Cross Blue Shield North Carolina Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Blue Cross Blue Shield North Carolina Benefits for Free
Blue Cross and/or Blue Shield (North Dakota)Blue Cross and/or Blue Shield (North Dakota) Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Blue Cross and/or Blue Shield (North Dakota) Benefits for Free
Blue Cross and/or Blue Shield (Oklahoma)Blue Cross and/or Blue Shield (Oklahoma) Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Blue Cross and/or Blue Shield (Oklahoma) Benefits for Free
Blue Cross and/or Blue Shield (Pennsylvania-Northeastern / Wilkes-Barre)Blue Cross of Northeastern Pennsylvania Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Blue Cross of Northeastern Pennsylvania Benefits for Free
Blue Cross and/or Blue Shield (Rhode Island)Blue Cross and/or Blue Shield (Rhode Island) Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Blue Cross and/or Blue Shield (Rhode Island) Benefits for Free
Blue Cross and/or Blue Shield (South Carolina)Blue Cross and/or Blue Shield (South Carolina) Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Blue Cross and/or Blue Shield (South Carolina) Benefits for Free
Blue Cross and/or Blue Shield (Tennessee)Blue Cross Blue Shield Tennessee Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Blue Cross Blue Shield Tennessee Benefits for Free
Blue Cross and/or Blue Shield (Texas)Blue Cross Blue Shield Texas Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Blue Cross Blue Shield (Texas) Benefits for Free
Blue Cross and/or Blue Shield (Vermont)Blue Cross and/or Blue Shield (Vermont) Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Blue Cross and/or Blue Shield (Vermont) Benefits for FreeContact Blue Cross and/or Blue Shield (Vermont) Directly
Blue Cross and/or Blue Shield (Wyoming)Blue Cross and/or Blue Shield (Wyoming) Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Blue Cross and/or Blue Shield (Wyoming) Benefits for Free
Blue Cross and/or Blue Shield Federal Employee PlanBlue Cross and/or Blue Shield Federal Employee Plan Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Blue Cross and/or Blue Shield Federal Employee Plan Benefits for Free
BridgeSpan HealthBridgeSpan Health Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your BridgeSpan Health Benefits for Free
Capital BlueCross – HarrisburgCapital BlueCross – Harrisburg Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your BridgeSpan Health Benefits for Free
CareFirst Blue Cross Blue ShieldCareFirst Blue Cross Blue Shield Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your CareFirst Blue Cross Blue Shield Benefits for Free
CHAMPVACHAMPVA Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your CHAMPVA Benefits for FreeContact CHAMPVA Directly
CignaCigna Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Cigna Benefits for Free
ConnectiCareConnectiCare Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your ConnectiCare Benefits for Free
CoOportunity HealthCoOportunity Health Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your CoOportunity Health Benefits for FreeContact CoOportunity Health Directly
Coventry Health CareNo weight loss surgery coverage criteria availableAsk Local Surgeon to Check Your Coventry Health Care Benefits for Free
CoventryOneNo weight loss surgery coverage criteria availableAsk Local Surgeon to Check Your CoventryOne Benefits for Free
Dean HealthDean Health Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Dean Health Benefits for Free
Definity HealthNo weight loss surgery coverage criteria availableAsk Local Surgeon to Check Your Definity Health Benefits for FreeContact Definity Health Directly
Emblem HealthEmblem Health Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Emblem Health Benefits for Free
Empire Blue Cross and Blue ShieldEmpire Blue Cross and Blue Shield Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Empire Blue Cross and Blue Shield Benefits for FreeContact Empire Blue Cross and Blue Shield Directly
Excellus BlueCross BlueShieldExcellus BlueCross BlueShield Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Excellus BlueCross BlueShield Benefits for FreeContact Excellus BlueCross BlueShield Directly
Fallon HealthFallon Health Weight Loss Surgery Coverage Criteria (use InterQual guidelines)Ask Local Surgeon to Check Your Fallon Health Benefits for Free
First HealthNo weight loss surgery coverage criteria availableAsk Local Surgeon to Check Your First Health Benefits for Free
Geisinger Health PlanGeisinger Health Plan Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Geisinger Health Plan Benefits for Free
Golden RuleGolden Rule Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Golden Rule Benefits for Free
Group HealthGroup Health Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Group Health Benefits for Free
HAP (Health Alliance Plan)No weight loss surgery coverage criteria availableAsk Local Surgeon to Check Your HAP (Health Alliance Plan) Benefits for Free
HCSCHCSC Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your HCSC Benefits for Free
Health NetHealth Net Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Health Net Benefits for Free
Health Plan of NevadaHealth Plan of Nevada Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Health Plan of Nevada Benefits for FreeContact Health Plan of Nevada Directly
Health Republic Insurance of New JerseyAsk Local Surgeon to Check Your Health Republic Insurance of New Jersey Benefits for FreeContact Health Republic Insurance of New Jersey Directly
HealthAmericaNo weight loss surgery coverage criteria availableAsk Local Surgeon to Check Your HealthAmerica Benefits for Free
HealthPartnersHealthPartners Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your HealthPartners Benefits for Free
HealthPlusHealthPlus Physician Guidelines for the Management of Obesity in AdultsAsk Local Surgeon to Check Your HealthPlus Benefits for FreeContact HealthPlus Directly
HealthSpanNo weight loss surgery coverage criteria availableAsk Local Surgeon to Check Your HealthSpan Benefits for Free
Highmark Blue Cross and/or Blue ShieldHighmark Blue Cross Blue Shield Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Highmark Blue Cross Blue Shield Benefits for Free
HIP Health Plan of New YorkHIP Health Plan of New York Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your HIP Health Plan of New York Benefits for Free
HMSA (Hawaii Medical Service Association)HMSA (Hawaii Medical Service Association) Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your HMSA (Hawaii Medical Service Association) Benefits for Free
Horizon Blue Cross and Blue ShieldHorizon Blue Cross and Blue Shield Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Horizon Blue Cross and Blue Shield Benefits for Free
HumanaHumana Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Humana Benefits for FreeContact Humana Directly
Independence Blue Cross – PhiladelphiaIndependence Blue Cross – Philadelphia Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Independence Blue Cross – Philadelphia Benefits for Free
Innovation HealthInnovation Health Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Innovation Health Benefits for Free
KaiserKaiser Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Kaiser Benefits for FreeContact Kaiser Directly
LifeWise Health Plan of OregonLifeWise Health Plan of Oregon Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your LifeWise Health Plan of Oregon Benefits for FreeContact LifeWise Health Plan of Oregon Directly
LifeWise Health Plan of WashingtonLifeWise Health Plan of Washington Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your LifeWise Health Plan of Washington Benefits for Free
MedicaMedica Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Medica Benefits for FreeContact Medica Directly
Medicare / MedicaidMedicare/Medicaid Weight Loss Surgery Coverage RequirementsAsk Local Surgeon to Check Your Medicare or Medicaid Benefits for Free
Medical Mutual of OhioMedical Mutual of Ohio Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Medical Mutual of Ohio Benefits for Free
MeritusMeritus Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Meritus Benefits for Free
Moda HealthModa Health Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Moda Health Benefits for Free
MVP Health CareMVP Health Care Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your MVP Health Care Benefits for FreeContact MVP Health Care Directly
My Health AllianceMy Health Alliance Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your My Health Alliance Benefits for Free
New Mexico Health ConnectionsNo weight loss surgery coverage criteria availableAsk Local Surgeon to Check Your New Mexico Health Connections Benefits for Free
Office of Group Benefits (OGB) PPOOffice of Group Benefits (OGB) Gastric Sleeve Insurance Coverage RequirementsAsk Local Surgeon to Check Your Office of Group Benefits (OGB) PPO Benefits for FreeContact Office of Group Benefits (OGB) PPO Directly
Optima HealthOptima Health Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Optima Health Benefits for FreeContact Optima Health Directly
OscarNo weight loss surgery coverage criteria availableAsk Local Surgeon to Check Your Oscar Benefits for FreeContact Oscar Directly
Oxford HealthOxford Health Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Oxford Health Benefits for FreeContact Oxford Health Directly
PacificSource Health PlansNo weight loss surgery coverage criteria availableAsk Local Surgeon to Check Your PacificSource Health Plans Benefits for Free
Physicians Health Plan (PHP)No weight loss surgery coverage criteria availableAsk Local Surgeon to Check Your Physicians Health Plan (PHP) Benefits for Free
Physicians PlusPhysicians Plus Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Physicians Plus Benefits for Free
PreferredOnePreferredOne Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your PreferredOne Benefits for Free
Premera Blue CrossPremera Blue Cross Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Premera Blue Cross Benefits for Free
PresbyterianPresbyterian Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Presbyterian Benefits for Free
Prevea360 Health PlanNo weight loss surgery coverage criteria availableAsk Local Surgeon to Check Your Prevea360 Health Plan Benefits for Free
PriorityHealthPriorityHealth Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your PriorityHealth Benefits for Free
Providence Health PlanProvidence Health Plan Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Providence Health Plan Benefits for Free
QualChoice – Federal Employees Health BenefitsQualChoice – Federal Employees Health Benefits Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your QualChoice – Federal Employees Health Benefits Benefits for Free
QualChoice – White County Medical CenterQualChoice – White County Medical Center Weight Loss Surgery Coverage CriteriaQualChoice – White County Medical Center Weight Loss Surgery Coverage Criteria
Regence Blue Cross and/or Blue ShieldRegence Blue Cross and/or Blue Shield Weight Loss Surgery Coverage CriteriaRegence Blue Cross and/or Blue Shield Weight Loss Surgery Coverage Criteria
Rocky Mountain Health PlansRocky Mountain Health Plans Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Rocky Mountain Health Plans Benefits for Free
Scott & White Health PlanScott & White Health Plan Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Scott & White Health Plan Benefits for FreeContact Scott & White Health Plan Directly
Security Health PlanNo weight loss surgery coverage criteria availableAsk Local Surgeon to Check Your Security Health Plan Benefits for Free
SelectHealthNo weight loss surgery coverage criteria availableAsk Local Surgeon to Check Your SelectHealth Benefits for Free
Sierra Health and LifeSierra Health and Life Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Sierra Health and Life Benefits for FreeContact Sierra Health and Life Directly
SummaCareNo weight loss surgery coverage criteria availableAsk Local Surgeon to Check Your SummaCare Benefits for Free
TennCareNo weight loss surgery coverage criteria availableAsk Local Surgeon to Check Your TennCare Benefits for FreeContact TennCare Directly
TriCareTriCare Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your TriCare Benefits for Free
Tufts Health PlanTufts Health Plan Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Tufts Health Plan Benefits for FreeContact Tufts Health Plan Directly
UnicareUnicare Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Unicare Benefits for Free
UnitedHealthOneUnitedHealthOne Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your UnitedHealthOne Benefits for Free
United HealthcareUnited Healthcare Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your United Healthcare Benefits for Free
Wellmark Blue Cross and Blue ShieldWellmark Blue Cross and Blue Shield Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your Wellmark Blue Cross and Blue Shield Benefits for Free
WINhealthWINhealth Weight Loss Surgery Coverage CriteriaAsk Local Surgeon to Check Your WINhealth Benefits for Free
WPS Health InsuranceNo weight loss surgery coverage criteria availableAsk Local Surgeon to Check Your WPS Health Insurance Benefits for Free
Insurance Companygastric sleeve insurance Coverage Policy
1199SEIU
Aetna
Altius
American Medical Security
  • No weight loss surgery coverage criteria available
AmeriHealth
Anthem Blue Cross and/or Blue Shield
Arches Health Plan
Arise Health Plan
Asuris Northwest Health
Blue Cross and/or Blue Shield (Alabama)
Blue Cross and/or Blue Shield (Alabama)
Blue Cross and/or Blue Shield (Arkansas)
Blue Cross and/or Blue Shield (California)
Blue Cross and/or Blue Shield (Florida)
Blue Cross and/or Blue Shield (Georgia)
Blue Cross and/or Blue Shield (Hawaii)
Blue Cross and/or Blue Shield (Idaho)
Blue Cross and/or Blue Shield (Illinois)
Blue Cross and/or Blue Shield (Illinois)
Blue Cross and/or Blue Shield (Kansas City)
Blue Cross and/or Blue Shield (Kansas)
Blue Cross and/or Blue Shield (Louisiana HMO)
Blue Cross and/or Blue Shield (Louisiana NON-HMO)
Blue Cross and/or Blue Shield (Massachusetts)
Blue Cross and/or Blue Shield (Michigan)
Blue Cross and/or Blue Shield (Minnesota)
Blue Cross and/or Blue Shield (Mississippi)
Blue Cross and/or Blue Shield (Montana)
Blue Cross and/or Blue Shield (Nebraska)
Blue Cross and/or Blue Shield (New Mexico)
Blue Cross and/or Blue Shield (New York – Northeastern)
Blue Cross and/or Blue Shield (New York – Western)
Blue Cross and/or Blue Shield (North Carolina)
Blue Cross and/or Blue Shield (North Dakota)
Blue Cross and/or Blue Shield (Oklahoma)
Blue Cross and/or Blue Shield (Pennsylvania-Northeastern / Wilkes-Barre)
Blue Cross and/or Blue Shield (Rhode Island)
Blue Cross and/or Blue Shield (South Carolina)
Blue Cross and/or Blue Shield (Tennessee)
Blue Cross and/or Blue Shield (Texas)
Blue Cross and/or Blue Shield (Vermont)
Blue Cross and/or Blue Shield (Wyoming)
Blue Cross and/or Blue Shield Federal Employee Plan
BridgeSpan Health
Capital BlueCross – Harrisburg
CareFirst Blue Cross Blue Shield
CHAMPVA
Cigna
ConnectiCare
CoOportunity Health
Coventry Health Care
CoventryOne
Dean Health
Definity Health
Emblem Health
Empire Blue Cross and Blue Shield
Excellus BlueCross BlueShield
Fallon Health
First Health
Geisinger Health Plan
Golden Rule
Group Health
HAP (Health Alliance Plan)
HCSC
Health Net
Health Plan of Nevada
Health Republic Insurance of New Jersey
HealthAmerica
HealthPartners
HealthPlus
HealthSpan
Highmark Blue Cross and/or Blue Shield
HIP Health Plan of New York
HMSA (Hawaii Medical Service Association)
Horizon Blue Cross and Blue Shield
Humana
Independence Blue Cross – Philadelphia
Innovation Health
Kaiser
LifeWise Health Plan of Oregon
LifeWise Health Plan of Washington
Medica
Medicare / Medicaid
Medical Mutual of Ohio
Meritus
Moda Health
MVP Health Care
My Health Alliance
New Mexico Health Connections
Office of Group Benefits (OGB) PPO
Optima Health
Oscar
Oxford Health
PacificSource Health Plans
Physicians Health Plan (PHP)
Physicians Plus
PreferredOne
Premera Blue Cross
Presbyterian
Prevea360 Health Plan
PriorityHealth
Providence Health Plan
QualChoice – Federal Employees Health Benefits
QualChoice – White County Medical Center
Regence Blue Cross and/or Blue Shield
Rocky Mountain Health Plans
Scott & White Health Plan
Security Health Plan
SelectHealth
Sierra Health and Life
SummaCare
TennCare
TriCare
Tufts Health Plan
Unicare
UnitedHealthOne
United Healthcare
Wellmark Blue Cross and Blue Shield
WINhealth
WPS Health Insurance

Can’t find your insurance company/plan or have an updated link?.

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Gastric Sleeve Insurance Coverage

If gastric sleeve insurance coverage is included under your policy, you will need to meet all of your insurance company’s coverage criteria (click here for list of insurance companies) to confirm the "medical necessity" of your surgery.

Assuming you follow all the guidelines and provide complete, accurate information requested by your insurance company, the gastric sleeve insurance approval process from start to finish can take anywhere from one month to one year.

Here is how to get insurance to pay for gastric sleeve:

  1. Minimum body mass index (BMI) requirements to be confirmed by your physician:
    • BMI over 40 –OR–
    • BMI over 35 with one or more of the following:
      • Clinically significant obstructive sleep apnea
      • Coronary heart disease
      • Medically refractory hypertension
      • Type 2 diabetes mellitus
  2. Complete a medically supervised diet program. gastric sleeve insurance criteria for the length of the program range from 3 to 7 consecutive months.
  3. Schedule a consultation with your bariatric surgeon.
  4. Schedule a consultation with your primary care physician to obtain a medical clearance letter.
  5. Schedule a psychiatric evaluation to obtain a mental health clearance letter.
  6. Schedule a nutritional evaluation from a Registered Dietitian.
  7. Send all of the above documentation to your insurance company along with a detailed history of your obesity-related health problems, difficulties and treatment attempts. The review process typically happens in under one month.
  8. Insurance company sends approval or denial letter:
    • If approved, your surgeon’s bariatric coordinator will contact you for scheduling.
    • If denied, you can choose to appeal the denial.

Your surgeon’s office will be very experienced in managing the above process and may have all of the required personnel on staff (e.g. registered dietitian, psychiatrist, bariatric coordinator, etc.).

Click here to access the weight loss surgeon directory to get started. Most offices will check your insurance for free to confirm coverage criteria.

Disability Insurance During Recovery

Your employer decides whether to offer Disability insurance (DI). You can continue coverage as an individual if you leave the company.

DI pays you a percentage of your monthly income if you are unable to work. Short term disability insurance (STD) usually pays 66 2/3 of your salary for the first 90 or 180 days of your recovery.

Disability insurance usually includes pre-existing conditions limitations. The best way around this is to sign up during the initial enrollment period (when you’re hired). They might not allow you to enroll at any other time. You then need to stay enrolled for the entire “pre-existing conditions exclusionary period,” which lasts between 6 and 12 months. Call your insurance company, talk with HR, or review your plan documents for details.

gastric sleeve insurance coverage

GASTRIC SLEEVE COST-AFTER-INSURANCE ESTIMATOR

Projected Out Of Pocket Costs After Insurance

PROJECTED OUT OF POCKET COSTS AFTER INSURANCE

Click Below to Update Your Plan's Details from U.S. Averages

The following variables may or may not impact your projected out of pocket costs.

GASTRIC SLEEVE
INSURANCE TOOLS

Cost-After-Insurance Estimator

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Choose your plan, state, and insurance company below.

Can’t find your insurance company/plan or have updated info?

Click to Collapse SectionClick to Learn More

Gastric sleeve cost with insurance is about $3,500, depending on your policy.

Following are average gastric sleeve costs after insurance pays, depending on plan type:

  • HMO: $1,475
  • PPO: $2,542
  • POS: $2,270
  • High-Deductible Health Plan: $1,901

(Click here for assumptions)

  • No money has been paid towards your calendar year deductible for other services
  • Calculations made using special formulas that take into account the average plan designs from Kaiser Family Foundation’s Annual Employer Health Benefits Survey (1)

Your final out of pocket cost after insurance depends on several factors, including:

  • Discounts Negotiated By Your Insurance Company

    Insurance companies often have pre-negotiated rates for doctors and hospitals in their network. They may also try to negotiate deeper discounts on top of any negotiated rates.

  • Calendar Year Deductible Level

    You must pay all medical costs until you reach your calendar year deductible amount. Some expenses, like copayments and prescriptions, do not count towards your deductible. Prescriptions may have their own Calendar Year Deductible.

    After you reach the deductible, you share the cost with the insurance company. The amount you share depends on your Coinsurance percentage (see below).

    Deductibles reset on January 1st. As a result, many weight loss surgery patients “rush” to get a surgery date before the end of each year.

  • Remaining Calendar Year Deductible Amount

    The amount of money you still owe towards your deductible.

  • Hospital Copay

    The amount you will pay for each hospitalization (including weight loss surgery). Does not count towards reaching the Calendar Year Deductible.

  • Hospital Coinsurance

    The percentage of the total bill you are required to pay after you have “paid off” your Calendar Year Deductible.

  • Out of Pocket Maximum

    This is the most you will have to pay through deductible and coinsurance before your plan pays 100%. You will still be responsible for copayments, such as:

    • Office visits
    • Hospital copays
    • Prescription drugs
  • Total Year-to-Date Coinsurance Paid

    The total amount of coinsurance you have paid so far this calendar year. This is needed to determine whether your weight loss procedure will cause you to reach your annual out of pocket maximum.

Click here to contact a top gastric sleeve surgeon and ask for a free insurance check.

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The average total gastric sleeve cost without insurance is $19,000. That drops to around $3,500 with insurance (see the section above).

While surgery can be expensive, the good news is that:

  • Even if your insurance policy does not cover gastric sleeve surgery, you still may be able to get your insurance company to pay for some of the costs. For example, many plans will pay for certain pre-op tests, such as lab work, office visits, and psychological screening.
  • Gastric sleeve patients save about $11,000 per year compared to the medical costs they would have incurred had they remained obese. In other words, gastric sleeve pays for itself in under two years.
  • Special discounts are usually offered to “self-pay” patients
  • Out-of-pocket costs may be tax deductible
  • Loans are available to make it more affordable

See our Gastric Sleeve Cost page for more information or click here to contact a top gastric sleeve surgeon to ask for a free cost quote.

Search the gastric sleeve surgeon directory below to find a top surgeon by country and region: