HealthPartners Weight Loss Surgery - How to Avoid a Denial

Your HealthPartners weight loss surgery insurance coverage depends on several factors, all of which are reviewed below.

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Read and click below for additional weight loss surgery insurance details.

HealthPartners Weight Loss Surgery

READ THIS FIRST

Even if your insurance company covers bariatric surgery in some plans, that does not mean that your specific plan covers it. The obesity surgery approval requirements in this section assume that weight loss surgery is covered by your specific policy.

To confirm whether your specific policiy covers bariatric surgery, click here to contact a surgeon and ask for a free insurance check.

Disclaimer: The information contained on this page may not include all components of your insurance company’s medical policy and/or may not be up to date. Contact your insurance company to confirm all benefits.

In order to be approved by HealthPartners for bariatric surgery in the United States, you must meet the following criteria:

  1. Be Age 18 years of age
  2. Diagnosis of Morbid obesity, defined as
  3. Or

    • BMI 35 – 39.9 AND one of the following
      • High blood pressure that is consistently greater than 140/90
      • Dyslipidemia
      • Clinically significant obstructive sleep apnea
      • Type II Diabetes
      • Pseudotumor cerebri

    Use this BMI Calculator to check your body mass index…

  4. Documentation of an evaluation by a mental health professional which addresses the following:
    • The need for any active therapeutic interventions for mental health issues and a plan on how these issues will be addressed
    • The ability of the member to participate in:
      1. Close nutritional monitoring during rapid weight loss
      2. Long term lifestyle changes
    • Certification that the member understands the full impact of surgery and post-op compliance
  5. At least one session of nutritional counseling with a clinical dietician and documentation of education as well as certification of member’s commitment to post-op compliance program
  6. Documentation of participation in an exercise program deemed appropriate for the member by the care team and documentation of member’s commitment to continue post-operatively
  7. Documentation by the weight loss surgery surgical team that any correctable endocrine disorders and/or other medical conditions have been ruled out
  8. Appropriate documentation and assertion by the operating surgeon that the member understands the surgical procedure chosen, the side effects, the risks, and the weight loss expectations/results
  9. Documentation of at least 5 completed sessions of the HealthPartners’ Weight loss surgery program phone course. For further information about this phone-based curriculum, please see the related content at the right. You will be referred into this program by your surgical team
  10. Documentation which certifies the member’s commitment to participation in close nutritional monitoring during rapid weight loss, long-term lifestyle changes, diet prescription, and medical surveillance after surgical therapy

If Your Policy Does NOT Cover It: Seek Partial Coverage

You may be able to get part of the costs paid for by insurance even if weight loss surgery isn’t covered. It’s all about how your doctor and hospital submit your claims to your insurance company.

For example, there are many non-bariatric surgery reasons for your doctor to recommend:

  • Cardiology exam
  • Lab work
  • Medically supervised diet program
  • Psychological exam
  • Sleep study

These are ordered for many reasons other than bariatric surgery and may be covered as a result. If your doctor submits one of these claims using a weight loss surgery CPT code (Current Procedural Terminology Code), your insurance is unlikely to cover it. But if your doctor uses a general CPT code, it probably will be covered.

While this may sound “sneaky”, it is an ethical practice. After all, these tests will be beneficial regardless of whether you move forward with surgery.

HealthPartners Weight Loss Surgery

Before getting into the types of insurance plans, you can cut to the chase by contacting a local bariatric surgeon’s office. Most surgeons will contact your insurance company for free to confirm whether or not you’re covered.

Click here to find a local surgeon and ask them to check your insurance for you for free.

HealthPartners does cover weight loss surgery, but your specific policy must include it in order for you get it covered.

Following are a list of HealthPartners plan types and whether they cover bariatric surgery:

Weight Loss Surgery for Health Plans Through Your Work

If you work for a company that has 50 or more full time employees, it is completely up to your employer to decide whether or not to cover bariatric surgery under your health plan.

To find out whether weight loss surgery is covered by your employer’s plan, you have a few options:

Weight Loss Surgery for Individual/Family Plans

The Affordable Care Act (Obamacare) requires all individual and small group plans (less than 50 full time employees) to include weight loss surgery coverage as long as it is considered an “Essential Health Benefit” in your state.

The following states DO currently consider bariatric surgery an Essential Health Benefit (bariatric surgery is covered by all individual, family and small group plans in these states):

Your State Not on the List?

If your state is NOT on the list, then weight loss surgery is probably NOT covered under your plan.

First, contact your local surgeon to be sure. For no charge, their office will contact your insurance company on your behalf to work through the details.

If your surgeon confirms that your policy does not include obesity surgery, you still have several options for making surgery more affordable. See these pages for more information:

    • 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

Regardless of whether your state is on the list, contact a qualified surgeon to request a free insurance check to verify your coverage.

To review your insurance company’s obesity surgery coverage requirements, click here to jump back up the page.

Weight Loss Surgery for Medicare Plans

All Medicare plans are required to cover the following weight loss surgery procedures:

However, special Medicare-specific criteria apply. Click here to learn more about Medicare bariatric surgery coverage.

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HealthPartners Weight Loss Surgery

Please see below for the procedures HealthPartners covers, might cover under certain circumstances, and those that are not covered under any circumstances:

Procedures That ARE Covered

Procedures That MIGHT BE Covered

The following procedures MIGHT BE covered by HealthPartners:

Procedures That Are NOT Covered

The following procedures are NOT covered by HealthPartners:

HealthPartners Weight Loss Surgery

If HealthPartners denies your weight loss surgery claim and you think it should be covered, consider filing an appeal.

Our Health Insurance Appeals page will get you started, then head over to the Disputes & Appeals page for to learn how to proceed.

Search the weight loss surgeon directory below to ask a top surgeon about a free insurance check by country and region: