Medical Weight Loss

Does insurance cover medical weight loss?

By Dr. Abdul Ahad Hayee

June 2nd, 2021

Last updated: June 2nd, 2021

While weight loss is a priority for a number of Americans, questions around cost and insurance are common. Is weight loss covered by insurance? How much does weight loss cost. Before starting on your journey, getting help answering these questions can ease stress and allow you to focus on achieving your weight loss goals. WellHealth answers a few of the most common questions so that you can get the right advice on the best weight loss option for you!

Does insurance cover weight loss?

Yes, some insurance plans will cover medical weight loss treatments, including surgery, medication, and weight loss plans such as the Enara weight loss program. Check with your insurance carrier to learn specifics of what they will cover, how much of the weight loss treatment they will cover and when you can qualify for coverage.

Why does insurance cover weight loss?

For more than 60 years, the World Health Organization has recognized obesity as a disease. In 2013 the American Medical Association went as far as to say obesity is a chronic disease warranting complete medical care. At the American Medical Association’s 2012 annual meeting, the members passed a resolution to “recommend that providers receive appropriate financial support and payment from third-party payers, thus ensuring that providers have an incentive to manage the complex diseases associated with obesity.”

The federal government and many state governments have pushed insurance companies to include weight loss services because obesity related illnesses are costly. All told, the United States spends anywhere from $147 billion to $210 billion per year to treat obesity. The majority of the spending comes from treating obesity-related diseases such as diabetes and cardiovascular disease. For an obese woman, treating obesity-related diseases costs an estimated $4,879 annually; for an obese man, obesity-related diseases costs an estimated $2,646 annually.

The Affordable Care Act includes provisions to help bend the cost curve on obesity-related spending. Now most health plans purchased through the marketplace include obesity screening and counseling with no copays or deductibles.

Do the largest health insurers in Texas pay for medical weight loss services?

Yes, the largest health insurers offer some form of medical weight loss coverage. However, coverage depends on the specific insurance plan. You should consult with your insurance carrier on what they cover and whether you qualify for coverage.

These are the top 10 largest insurance companies in Texas as ranked by annual premiums collected and market share:

  1. Blue Cross Blue Shield of Texas
  2. Humana Insurance
  3. Aetna Life Insurance
  4. Superior Healthplan Network
  5. Care Improvement Plus of Texas
  6. Cigna Health and Life Insurance
  7. Celtic Insurance
  8. Amerigroup Insurance
  9. Metropolitan Life Insurance — Weight loss coverage not offered
  10. Dentaquest USA Insurance — Weight loss coverage not offered

What weight loss treatments do insurers cover?

Your insurance may cover surgical and nonsurgical medical weight loss options.

Weight loss surgeries, known as bariatric surgeries, typically require meeting with a medical team, including a primary care doctor, surgeon, anesthesiologist, dietitian, and psychologist. Some of the more popular bariatric surgeries include sleeve gastrectomy, gastric bypass and adjustable gastric band surgery.

Non-surgical medical weight loss options include programs set up by nutritionists and dietitians. The Enara Health weight loss program at WellHealth is a science-based approach to sustainable weight loss. Weight loss therapists use your genetic profile to determine which meal plans, exercise regimens and emotional environments are best for weight loss.

Do I qualify for weight loss insurance coverage?

For most health insurers, to qualify for medical weight loss services you must be able to prove that you have been unsuccessful losing weight with diet and exercise alone. You typically also must have a body mass index, or BMI, of 40 or higher. Insurers often will allow a lower BMI for medical weight loss coverage if you also have obesity-related illnesses that could be improved with weight loss services (Manning, 2020). Some of those obesity-related illnesses include:

  • High blood pressure
  • Sleep apnea
  • Asthma
  • Breathing disorders
  • Arthritis
  • Cholesterol abnormalities
  • Gastroesophageal reflux disease
  • Fatty liver disease
  • Venous stasis
  • Urinary stress incontinence

How can I get insurance to cover weight loss treatment?

If you have been denied coverage for medical weight loss services, try contacting your human resources department. Oftentimes they are in a better position to verify your specific coverage and can advocate on your behalf.

Your primary care physician can help you collect data and documents that could help your case with the insurer. Sometimes, a letter from your doctor could be the deciding factor in getting coverage approved. When crafting a letter to the insurer, it’s important to keep it focused on the facts. Insurers typically aren’t swayed by emotional appeals for why they should spend money.

If you are repeatedly denied, you may be able to get help through your state Department of Insurance. Most state departments have staff trained at helping consumers with denials.

The Enara weight loss program is in network with many of the largest insurance carriers in Texas, including UnitedHealthcare, Anthem, Cigna, Humana, BlueCross BlueShield of Texas, and Medicare. With insurance, Enara’s revolutionary approach to weight loss costs $99 a month. For patients choosing to pay without insurance, the Enara program costs $450 a month.

Can I use my HSA, FSA or HRA to pay for medical weight loss?

Yes, you can use your Health Savings Account, Flexible Spending Account or Health Reimbursement Account to pay for medical weight loss. To better understand the difference between the three different spending accounts:

• An HSA, or Health Savings Account, is a non-taxable account you can use to withdraw from for qualified expenses. Your balance rolls over from year to year. • An FSA, or Flexible Spending Account, is a non-taxable account with a $2,500 maximum that you contribute to throughout the year. Generally, you are not able to roll over the balance to the following year. • An HRA, or Health Reimbursement Account, is an employer-funded benefit plan that reimburses workers for out-of-pocket medical expenses and individual health insurance premiums. HRA balances often do roll over from year to year.

If your weight loss procedure is a medically supervised program it should be eligible as a qualified medical expense for an HSA, FSA or HRA. The Enara program, for instance, is a medically supervised weight loss program, so it qualifies for those health care spending accounts.

By Dr. Abdul Ahad Hayee