Does Medi Cal Cover Weight Loss Surgery?

If you are considering undergoing weight loss surgery, you may have been considering Medical insurance as well. The confusion that many people have had about Medical insurance and weight loss surgery is that they see the two terms used interchangeably. While both health insurance plans provide many of the same benefits and coverage options, there are differences in the cost and the eligibility requirements for Medi Cal insurance. Here is a closer look at the differences between Medical insurance and weight loss surgery.

Medi Cal is a type of insurance plan created by the California health insurance department. This insurance program offers insurance to residents in the 35 states along with some other states that have expanded the program. Medical insurance does not pay for elective surgeries such as gastric bypass surgery. Additionally, Medical insurance does not pay for the cost of medications that are used to treat certain medical conditions and that are approved by the FDA.

The Medical plan does offer many benefits to patients who have an obesity issue. Medi Cal covers the costs of physical therapy and can even help cover hospital bills associated with surgery. If you are looking at having a bariatric surgery, you will need to get a letter from your physician stating that you meet the standards for weight loss surgery. The letter must be signed and then presented to Medi Cal before the surgery can proceed. The documentation that you need to present when you go to the doctor to get this letter should also be presented with your Medi Cal application.

The surgery covering issue does have exceptions. One of those includes the cost of outpatient surgery at a clinic other than a surgical center. Even if you have a prescription from a surgeon that says that you meet the standards for weight loss surgery, your Medi Cal plan will not cover the cost of the surgery. If you choose to have the surgery at a different clinic other than the one where you had the original prescription, you will have to pay the additional cost of your procedure out of pocket. In this case, your physician's letter should be presented to indicate that you opted to have the surgery at a different clinic.

Another exception to the coverage of Medi Cal comes when you have chosen to have gastric bypass surgery. Depending on how much of your stomach is removed, the portion of your food that you can take in may change. Your Medi Cal provider should give you information about this potential drawback to your weight loss surgery. Because of this potential issue, you will probably have to pay for the additional cost of outpatient surgery at a specialist clinic.

Finally, you may be allowed to use tobacco or use drugs while under the care of the weight loss surgery. These drugs and products can have side effects that will negatively affect your ability to lose weight and can increase your risks of developing health problems related to surgical procedures. As such, you will not be allowed to take these medications after surgery as part of your Medi Cal coverage.

While it is true that Medi Cal allows you to use tobacco and drugs, these benefits may not always be available. If you do lose a significant amount of weight through the use of an appetite suppressant or similar product, your Medi Cal provider may refer you to a weight loss clinic that offers these products. Even if you are allowed to take tobacco products after the surgery, you may not necessarily lose enough weight to qualify for full coverage.

It is important that you carefully consider all of your options prior to having any type of weight loss surgery. Ask questions and find out what the costs, risks, and outcomes are for your desired results. If you are thinking about gastric bypass surgery, ask for a pre-operative and post-operative evaluation. You should also find out about the cost of prescription medications you will need after your procedure as well as the potential impact of dieting and exercise on your health after your procedure. Medical insurance does not have to cover weight loss surgery; you will need to check with your specific plan to determine if it is a part of the package that is offered.