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Bariatric Surgery Insurance Exclusions

Bariatric surgery is also known as “metabolic surgery” or “weight loss surgery.”

While losing excess weight can be one obvious and visible benefit coming from these procedures, it isn’t the main reason most people try to get insurance to cover them.

Most patients want weight loss surgery to improve health conditions associated with severe obesity including:

  • Type 2 diabetes
  • Hypertension (high blood pressure)
  • Sleep apnea
  • Heart disease
  • Gastroesophageal reflux disease (GERD)

There are different types of bariatric surgical procedures, which work in different ways. Some operations succeed by restricting caloric intake (e.g., sleeve gastrectomy or gastric banding) while others affect how the body absorbs food (e.g., gastric bypass, duodenal switch or SADI-S).

Today, most bariatric operations are performed using small incisions (called laparoscopy) and are very safe and effective, especially when patients have the support offered by a specialized, multidisciplinary team.

While insurers may use a variety of reasons to deny coverage for these life-saving treatments, there are no patient advocates today who possess the same scope of expertise and knowledge regarding bariatric surgery insurance exclusion as PRIA Appeals.

We are passionate and compassionate experts with a deep understanding of the reasons insurance companies deny bariatric surgery, and the drive and determination to help you get the care you need. We understand what you are going through and can help you through it every step of the way until you get approved.