Chelsey Tucker graduated with a Bachelor of History degree from Metropolitan State University in 2019. She now writes about insurance with her specialty being life insurance and has been quoted on Help Smart Phone and MEL Magazine.

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Dan Walker graduated with a BS in Administrative Management in 2005 and has been working in his family’s insurance agency, FCI Agency, for 15 years. He is licensed as an agent to write property and casualty insurance, including home, auto, umbrella, and dwelling fire insurance. He’s also been featured on sites like Reviews.com.

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Reviewed by Daniel Walker
Licensed Auto Insurance Agent

UPDATED: Mar 19, 2020

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Find health insurance after weight loss surgery

When you are applying for health insurance after weight loss surgery, it’s important to be honest when providing health information. This will help you to obtain a policy that both meets your needs and is reliable.

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Depending on the company and the plan involved, the surgery may be considered a pre-existing condition for insurance purposes. You may have to serve a waiting period before you qualify for medical coverage, but there is an exception to this rule for people who had group health insurance coverage through an employer health plan.

Pre-Existing Conditions and Health Insurance

A person who applies for health insurance coverage on an individual basis must go through the company’s underwriting process. The insurance company’s underwriters consider the person’s current and past health records to determine the likelihood that the applicant will be making claims against the policy. Generally speaking, a person who is young and healthy can qualify for lower rates for health insurance coverage.

Pre-existing conditions for health insurance purposes are anything that a person sought medical advice or treatment for in a set period before the new health insurance policy took effect. The insurance company will go back 12 months or more for this purpose.

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Private Health Insurance Plan

Having surgery always carries with it a certain level of risk, but weight loss surgery may be evaluated differently because as the patient loses weight, his or her overall health is expected to improve. The insurance company may want the patient to get his or her weight down to a more healthy level and keep it off for a set time before the individual will be able to qualify for health insurance rates.

Even if a person who has had weight loss surgery is accepted for health insurance coverage, the plan may exclude claims connected with it. This means any follow-up visits afterward or treatment needed for complications after the surgery will not be covered. You will need to pay for those expenses yourself. Other health concerns not related to the weigh loss surgery will be covered according to the policy provisions.

Each health insurance plan has its own rules for evaluating risk and determining eligibility for coverage. Rates can vary between companies and also depend on the type of plan chosen. Health insurance consumers who want to get lower rates and are agreeable to getting care from a set network of providers can consider a HMO (Heath Management Organization) plan.

Shopping around for health insurance coverage makes good sense. It’s important to be completely honest when filling out the forms, though. Failing to disclose your entire medical history may mean the entire policy will be voided and you will have been paying premiums for nothing.

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Employer Health Insurance

The exception to the pre-existing condition rule and coverage comes into play when you are enrolled in a group health insurance plan through your employer. If you were previously covered by an employer health plan for a minimum of 12 months and you have not had a lapse in coverage of more than 63 days, you don’t have to serve a waiting period under a new employer health plan. Any claims relating to the weight loss surgery would be covered under the provisions of the plan.

In a case where you are starting a new job and want to enroll in the company health insurance plan, you cannot be turned down for coverage. The health insurance company agrees to provide coverage for all group members. It can impose a waiting period of up to 12 months for new plan members for pre-existing conditions.

If, during the six months before enrolling in the employer’s health insurance plan, you did not consult with a doctor about any health issues relating to the weight loss surgery, it will not be considered a pre-existing condition. Any health services relating to the surgery provided after you enroll in the plan will be covered, though.

Finding health insurance coverage after weight loss surgery involves considering your options and shopping around for coverage. You may be able to get private health insurance after the procedure, but be sure to get quotes from a number of providers and consider the type and level of coverage you are getting carefully before making a buying decision.

Group health insurance through an employer is another option for people who have had weight loss surgery. Even though you may need to serve a waiting period before you can get coverage for expenses relating to the surgery, you cannot be turned down for coverage.

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