What States Require Insurance Companies to Cover Weight Loss Surgery

Title: What States Require Insurance Companies to Cover Weight Loss Surgery?


Weight loss surgery, also known as bariatric surgery, has become an effective solution for individuals struggling with obesity and related health issues. However, the cost of such procedures can be a significant hurdle for many. Fortunately, some states in the United States have recognized the importance of this surgery and have enacted laws that mandate insurance companies to cover weight loss surgery. In this article, we will explore which states require insurance coverage for weight loss surgery and answer some commonly asked questions regarding the topic.

States Requiring Insurance Coverage for Weight Loss Surgery:

As of 2021, the following states have laws in place that require insurance companies to cover weight loss surgery:

1. California
2. Colorado
3. Connecticut
4. Illinois
5. Indiana
6. Louisiana
7. Maryland
8. Massachusetts
9. Michigan
10. Montana
11. New Hampshire
12. New Jersey
13. North Carolina
14. Rhode Island
15. South Carolina
16. Texas
17. Vermont
18. Washington
19. West Virginia
20. Wisconsin

These states acknowledge the potential health benefits of weight loss surgery, such as reducing the risk of diabetes, heart disease, and other obesity-related conditions. However, it is essential to check with your specific insurance provider for detailed coverage information as policies may vary.

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Common Questions and Answers:

1. What is weight loss surgery?
Weight loss surgery refers to a series of surgical procedures aimed at helping individuals with obesity lose weight altering the digestive system’s anatomy.

2. How much does weight loss surgery cost?
The cost of weight loss surgery can vary significantly depending on the specific procedure, geographical location, and individual insurance coverage. Generally, it can range from $15,000 to $30,000.

3. Does insurance cover weight loss surgery in all states?
No, not all states require insurance companies to cover weight loss surgery. However, the list mentioned earlier outlines the states that have mandated coverage.

4. Does every insurance plan cover weight loss surgery?
While the states mentioned above require coverage, it is important to check your specific insurance plan as coverage details may vary between policies.

5. What criteria must be met to qualify for weight loss surgery coverage?
Typically, insurance companies require individuals to have a body mass index (BMI) of 35 or higher with obesity-related health conditions, or a BMI of 40 or higher without additional health conditions.

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6. Is prior authorization required for weight loss surgery coverage?
Yes, most insurance companies require prior authorization to ensure that the surgery is medically necessary.

7. Are there any age restrictions for weight loss surgery coverage?
Age restrictions may vary between insurance providers. However, most insurers require patients to be at least 18 years old.

8. What types of weight loss surgeries are covered insurance?
Insurance coverage may include procedures such as gastric pass, gastric sleeve, and gastric banding, among others. The exact coverage may differ based on your insurance plan.

9. Are there any non-surgical weight loss options covered insurance?
Certain insurance plans may cover non-surgical weight loss options such as medically supervised weight loss programs or prescription weight loss medications. It is important to review your policy for specific coverage details.

10. Does insurance cover weight loss surgery for cosmetic purposes?
No, insurance typically does not cover weight loss surgery if it is deemed purely cosmetic and not medically necessary.

11. Can insurance coverage for weight loss surgery be denied?
While states may require coverage, individual insurance companies have the authority to evaluate individual cases and may deny coverage if certain criteria are not met.

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12. Are there any out-of-pocket expenses for weight loss surgery?
Out-of-pocket expenses may vary depending on your insurance plan and coverage details. Co-pays, deductibles, and other fees may apply.

13. Can weight loss surgery coverage be obtained through employer-sponsored plans?
Yes, many employer-sponsored health insurance plans provide coverage for weight loss surgery. It is important to review your specific plan’s coverage details.

14. What documents are typically required for insurance coverage approval?
Insurance companies usually require medical records, documentation of previous weight loss attempts, letters of medical necessity, and a detailed surgical plan from your healthcare provider.


Weight loss surgery can be a life-changing procedure for individuals battling obesity. Fortunately, several states in the U.S. have recognized the importance of this surgery and require insurance companies to cover it. If you are considering weight loss surgery, it is crucial to understand your insurance coverage and requirements. Always consult with your insurance provider and healthcare professionals to determine the best course of action for your individual needs.

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