Health insurance for weight loss surgery

About the authorAs health insurance publisher, Alex Holderness is trying to make a confusing topic easy to understand. She moved to Sydney from the UK six years ago and her words have been published in various health and tech publications. When she's not digging into insurance policies, you'll find her triathlon training.

What weight loss surgeries are available?

There are several options for weight loss surgery, and private health insurers can cover many of them.

The public health care system is largely out of the picture for most people because they only accept the most extreme cases and only after you've met a long list of requirements.

Either way, you won't be approved until you meet with a physician for an in-depth, face-to-face consultation. If the physician recommends surgery, it will usually be for one of the following:

• Lap band (also called gastric banding). In this laparoscopic procedure, the surgeon wraps a silicone band around the top portion of your stomach, creating a small pouch for your food. This limits the amount of food you can fit in your stomach and causes you to feel full sooner.
• Sleeve gastrectomy. With this surgery, the surgeon reduces the size of your stomach by permanently removing a section of it. Like the lap band, this causes you to feel full quicker and to eat less.
• Gastric bypass. This is where the surgeon divides your stomach into two sections, then connects your small intestine to the smaller of the new stomach sections. This helps you to eat less, absorb fewer calories and react negatively to sugar.
• Duodenal switch. Here, the surgeon removes a section of the stomach (as they would with a sleeve gastrectomy) and then relocates the bottom of the stomach further down the small intestine. Like the gastric bypass, this procedure causes you to eat less and absorb fewer calories.
• Liposuction. In this procedure, the surgeon sticks a small tube into your body and sucks the fat out with a vacuum. It doesn't affect your appetite.
• Lap band reversal. This is if you have the lap band removed because it's ineffective or causes problems.

Does Medicare cover weight loss surgery?

The public health care system is largely out of the picture for most people because they only accept the most extreme cases and only after you've met a long list of requirements.

You won't be approved until you meet with a physician for an in-depth, face-to-face consultation.

How much does weight loss surgery cost?

Without health insurance, weight loss surgery can cost upwards of $20,000. Private health insurance will knock quite a bit off of this by helping out with physician consultations, accommodation in a private or public hospital, anesthetist fees and post-op doctors’ fees.

Naturally, you'll be responsible for the excess but you can also expect a number of other out-of-pocket expenses. Your physician will discuss any additional fees with you before the procedure.

Which private health insurers cover weight loss surgery?

If Medicare's not an option, most private insurers will have a policy that covers weight loss surgery. It will cost you some money since it’s considered a top-tier policy. However, that premium pales in comparison to the potential savings and health benefits. First, you'll need to find a hospital policy that covers it and then you'll have to serve the waiting period – usually 12 months.

Be aware that not every insurer who offers this type of insurance covers every form of surgery. The following table shows which insurers from finder partners offer weight loss surgery.

_{*prices based on a single male living in NSW.}

What other treatments are available?

Health insurance can help toward the cost of several other treatments when it comes to losing weight, from gym membership discounts to programs such as Weight Watchers and Jenny Craig. These services can be found in your extras cover - so it’s always work checking limits allowed.

A snapshot of some example services can be found below:

• finder panel

Weight loss programs covered by insurance providers in the finder.com.au panel

Health fund	Policies that include cover for weight loss services	Find out more
	HIF Saver, Special, Super and Premium extras cover policies offer cover for recognised weight loss programs. HIF approved providers include Weight Watchers, Jenny Craig, Michelle Bridges' 12 Week Body Transformation Program and more.	More info
	Health.com.au Extras 50, Basic Extras, Middle Extras and High Extras policies include a benefit that covers weight loss management services. Be aware that Basic, Middle and High Extras can only be purchased as a combined policy with hospital cover.	More info
	ahm includes a benefit towards the cost of weight loss programs in the Basic, Lifestyle, Family and Super extras cover policies. The weight loss program has to be undertaken with an ahm recognised provider, which are Weight Watchers, Jenny Craig, Fernwood and Slimplicity.	More info
	Australian Unity offers a benefit on weight loss programs, which is available through the Smart Combination, Smart Essentials and Smart Start combined hospital and extras policies. Programs approved by Australian Unity are Weight Watchers, Jenny Craig, Sure Slim, Curves Complete and Ultralite.	More info
	GMHBA's Gold Extras policy provides cover for Weight Management Council of Australia member programs which include Weight Watchers, Jenny Craig Weight Loss Centres, Fernwood and Simplicity Weight Loss.	More info
	HCF Silver Plus, Gold and Platinum Extras policies provide a benefit for weight loss programs taken through an approved provider and may cover some of the expenses of weight loss medication.	More info
	nib Top and Core Wellbeing Extras policies include a benefit that pays towards weight loss management programs that are approved by the health fund, which include Jenny Craig and Weight Watchers.	More info
	Family By Design Combined Cover allows policyholders to claim for weight loss programs.	More info

_{*Restricted funds only provide cover to members of specific industries, groups and organisations. In some cases family members may also be eligible to join.}

Can anyone get weight loss surgery?

Choosing to get weight loss surgery is a significant life decision that is often very emotional. Health professionals understand that and want to know that this course of treatment is right for you, and that they are making the right decision to treat you.

That means not everyone who wants weight loss surgery will be able to get it.

Here's what's required in the public and private systems:

• In the public system. Medicare has exact requirements, including that you have a body mass index (BMI) of at least 35, demonstrate that you've failed using other approaches and undergo a psychological evaluation.
• In the private system. Private health insurers will require you to have a face-to-face consultation with a physician to determine if the surgery is necessary, and some insurers may require you to have a BMI above a specific number. However, these requirements are less restrictive than Medicare's.

What's the right type of cover for someone looking to lose weight?

If you're serious about losing weight, you'll want a policy that helps you not only kick those kilos to the curb, but that also helps you keep them there. For the best results, look for policies that offer the following:

• Cover for weight loss surgery. You'll usually only find cover for weight loss surgery in insurers' top-level hospital policies. If you're not already on one, you'll want to get on one soon because there will be a waiting period, usually around 12 months.
• Cover for weight management. You'll also want an extras policy that covers other weight management programs like fitness classes and nutritional consulting. This will give you a chance to learn new wellness habits pre-surgery and to keep them fresh post-surgery. Waiting periods for weight management cover are a lot shorter, usually around two months.

Do these weight management programs include acupuncture?

If your extras policy includes weight management cover, you'll probably be able to squeeze out a few acupuncture sessions. Here's how:

• Use an approved provider. To claim under weight management, you'll usually have to use one of your insurers' approved providers. If acupuncture is listed, you can claim.
• Get a doctor's note. If there aren't any acupuncturists on the approved providers list, presenting a doctor's note should get you approved.
• Claim under "natural therapies". If you already have weight management cover (an extra), there's a good chance your policy includes acupuncture under the natural therapies section (also an extra). If so, there's nothing stopping you from claiming for acupuncture under that section of your policy.

What if I have to switch health funds to get covered?

There aren't a whole lot of drawbacks to switching insurers to grab a better policy.

You won't have to re-serve waiting periods for items you've already served, but you will have to serve waiting periods for any new areas of cover. In this case, your cover for weight loss surgery is presumably new, so you'll have to sit tight until that waiting period is up. However, that's no different than if you'd upgraded policies with your existing insurer.

Some insurers give you loyalty benefits for sticking around a while, such as reduced excesses. You will forfeit these, but you can always try to negotiate similar perks with the new guys.

In summary: Do health funds cover weight loss programs or surgeries?

There are multiple procedures available to people who are obese to assist with weight loss, such as gastric bypass or banding surgery, which Medicare can provide cover for if you meet pre-approval requirements. Private health insurance may also cover weight reduction programs and surgeries too.

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