Does Insurance Cover Endoscopic Sleeve Gastroplasty?

Obesity is one of the major health problems facing the United States currently. It is estimated that more than 40% of the US population is classified as obese.

This scourge has been increasing over the years, in 1963 the obesity rate was 13.2% compared to the percentage in 2016 that exceeded 40%. This health problem must be addressed and taken into account for a better lifestyle.

To counteract this problem, today there are many weight loss methods and procedures, not only bariatric surgery but also non-surgical weight loss procedures. One of the obstacles that our patients have encountered when starting their weight loss journey has been economic issues.

For example, one of the big questions asked by our patients at Innova Weight Loss Solutions has been ‘Does my health insurance cover endoscopic sleeve gastroplasty?’ Today we will be discussing this topic and how weight loss procedures are related to the companies that provide health insurance.

Does Insurance Cover Weight Loss Surgery?

It should be noted that not all companies that provide health services cover bariatric or weight loss procedures, each company has different requirements to access some bariatric procedures. One of the most important requirements is to take into account the BMI of the patients; in some cases, it will depend on the BMI value to determine if the patient suffers from mild, normal, or morbid obesity.

The fact of having a high body mass index does not mean that the companies providing health insurance are obliged to cover the patient’s bariatric surgery. According to several studies, the people who are most often considered candidates for bariatric surgery and who may be covered by their health insurance are:

  • Patients who have tried to lose weight through diet and exercise, but have not obtained the expected results;
  • Have a body mass index of 40 or more;
  • Have a body mass index of at least 35+ and have obesity-related health problems such as type 2 diabetes, high blood pressure, etc.

These conditions are generic and do not mean that by meeting these requirements, the health insurance company will cover the costs of bariatric procedures. We recommend that patients contact their health insurance provider to get a more general idea of what is needed to obtain coverage for weight loss surgery.

Should All Insurance Companies Cover Bariatric Surgery?

Bariatric surgery is required in 23 states to be included in health plans that comply with government regulations. Surgery or non-surgical weight loss procedures should be covered by insurance plans for some of the following reasons:

Improvement in the general health of the patient: These benefits, which have been studied for many years, have shown that patients suffering from type 2 diabetes can achieve complete control of this condition after a weight loss procedure. As well as sleep apnea, high cholesterol, joint problems, and gastric reflux among others.

Bariatric Surgery And Insurance Coverage

Insurance companies are very strict when considering a procedure as necessary for the health of a patient and the procedures that will be considered cosmetic. These companies are also slow to take into account the technological advances in medicine and adopt new techniques and procedures that have proven to be very effective in losing weight.

Today, many insurance companies agree to cover all bariatric surgeries like gastric bypass, gastric sleeve, and gastric band surgery. We recommend that patients find out if their health insurance company has detailed information on bariatric coverage and be sure to take the following steps into account:

  • Review the coverage details in the health insurance policy;
  • Find out whether or not the surgeon is qualified and affiliated with the network of providers of weight loss procedures;
  • Find out if you can qualify for surgery;
  • Contact the doctor’s office to confirm eligibility and coverage with the insurance company.

Are you interested in losing weight with state-of-the-art solutions? Please schedule an appointment online and our team will contact you shortly!

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Why Health Insurance Should Cover Endoscopic Sleeve Gastroplasty

Currently, health insurance plans do not cover endoscopic sleeve gastroplasty (ESG). However, our team at Innova Weight Loss Solutions believes that this highly effective procedure should be covered by medical insurance. The endoscopic gastric sleeve has made its way into the field of weight loss.

After all, it is as effective as gastric sleeve surgery and it has fewer complications than any surgery because there are no incisions. Endoscopic sleeve gastroplasty was approved by the FDA in July 2022 and is likely to be covered by health insurance plans in the future.

Complications from bariatric surgery translate into higher medical costs to address these complications. Gastric sleeve surgery has a complication rate of up to 13%, which is quite a lot if we compare it with the 2% of complications that endoscopic sleeve gastroplasty (ESG) can have.

Bearing in mind that bariatric surgeries are in a price range between $14,000 and $23,000 without taking into account that the length of stay in the hospital can vary from 3 to 5 days, we could conclude that these high costs become a great opportunity for insurance companies to reduce overall healthcare costs by considering non-surgical weight loss options like endoscopic sleeve gastroplasty.

We are only considering the costs of the surgery, not taking into account that bariatric surgeries typically covered by health insurance carry costs related to hospital stays and complications. In addition, costs related to obesity-related diseases, including prescription drugs, would generally decrease as patients lost weight and became healthier. We are confident that in the future patients will be able to access non-surgical weight loss procedures covered by health insurance.

What Do I Do If My Insurance Does Not Cover ESG?

If a patient wishes to undergo a procedure like endoscopic sleeve gastroplasty (ESG) that is not currently covered by health insurance, they have different options to begin a weight loss journey.

Most weight loss clinics work with companies that offer medical loans to help patients finance necessary procedures. Innova Weight Loss Solutions has an agreement with Carecredit to be able to access our services quickly and easily. Another good option is to start medical nutrition therapy to begin losing weight and adopt healthier habits that help achieve the desired goals.

If you are interested in the ESG procedure or beginning a weight loss journey, please contact us or request an appointment at our New York or Puerto Rico offices. During your consultation, the trained and professional staff will answer your questions about different weight loss options and help you create a personalized plan to achieve your goals.

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