Does IEHP cover weight loss surgery? More than 40% of adults in the United States are considered obese, making obesity a significant public health concern. The condition is linked to a number of health issues and a decreased quality of life. For those battling with obesity, weight loss surgery has grown in popularity.
But for many people, the expense of these operations can be a major deterrent. This article will examine whether IEHP covers weight reduction surgery, as well as what procedures are eligible for coverage and the prerequisites.
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What is IEHP?
Residents of San Bernardino and Riverside counties in Southern California are covered by the non-profit Inland Empire Health Plan (IEHP). Preventive care, urgent care, and prescription medications are all covered by the organization. The IEHP is a Medi-Cal managed care program that offers coverage to people who are eligible for the Medi-Cal program.
What is a weight-loss operation?
Changes to the digestive tract are made during weight reduction surgery in order to aid with weight loss. There are many different weight loss surgical procedures, but gastric bypass, sleeve gastrectomy, and adjustable gastric banding procedures are the most popular ones.
Bypassing the top part of the small intestine and the rest of the stomach, a gastric bypass involves constructing a small stomach pouch and rerouting the small intestine to this pouch. With a sleeve gastrectomy, a piece of the stomach is removed to make room for a new, smaller, banana-shaped stomach.
A band is wrapped around the upper portion of the stomach during adjustable gastric banding, resulting in a reduced stomach pouch.
Is weight loss surgery covered by IEHP?
Depending on the treatment and the patient, different insurance plans may or may not cover weight loss surgery. However, for those who qualify, IEHP typically pays for weight loss surgery. For people who meet certain requirements, weight loss surgery is regarded by IEHP as a covered benefit.
Eligibility criteria for coverage of weight loss surgery
A person must meet certain criteria to be eligible for weight loss surgery coverage through IEHP. These criteria may include the following:
For weight loss surgery to be covered, a person’s body mass index (BMI) must be 40 or higher. A person with a BMI of 35 to 39.9 may occasionally be given consideration for coverage if they also have additional weight-related health issues, like diabetes or high blood pressure.
Additional health issues:
A person must also have additional weight-related health issues, such as diabetes, hypertension, or sleep apnea.
Previous weight-loss attempts:
A person must have tried to reduce weight using other strategies, such as diet and exercise, without success.
The age range for eligibility is 18 to 65.
To make sure they are psychologically ready for the procedure and the lifestyle adjustments that will be necessary afterward, a person must undergo a psychological evaluation.
Procedures for weight loss covered by IEHP
The health plan known as IEHP, or Inland Empire Health Plan, is situated in California and offers coverage for a range of treatments and operations, including weight loss surgery. The procedures covered by IEHP for weight loss surgery include:
Having a gastric bypass:
Roux-en-Y gastric bypass is another name for the surgical technique known as gastric bypass, which includes rerouting a section of the small intestine and forming a tiny stomach pouch. Patients who meet certain requirements, such as having a body mass index (BMI) of 40 or more or a BMI of 35 or higher with at least one obesity-related medical condition, are covered by IEHP for this procedure.
The surgical operation known as a sleeve gastrectomy, sometimes known as a vertical sleeve gastrectomy, involves cutting out a section of the stomach and creating a smaller stomach pouch. For individuals who meet specific requirements, such as a BMI of 40 or higher or a BMI of 35 or higher with at least one obesity-related medical condition, IEHP will pay for this surgery.
Gastric banding that is adjustable:
A band is wrapped around the top portion of the stomach during adjustable gastric banding, sometimes referred to as lap band surgery, in order to reduce the size of the stomach pouch. For individuals who meet specific requirements, such as a BMI of 40 or higher or a BMI of 35 or higher with at least one obesity-related medical condition, IEHP will pay for this surgery.
It’s crucial to remember that IEHP has certain requirements that patients must complete before being approved for weight reduction surgery, including a history of unsuccessful attempts at non-surgical weight loss approaches like diet and exercise and a doctor’s medical clearance.
Additionally, a pre-surgery evaluation process involving psychological, medical, and dietary evaluations is required of the patients. The three weight loss procedures that are covered by IEHP are gastric bypass, sleeve gastrectomy, and adjustable gastric banding. To be approved for these treatments, patients must fulfill specific requirements and take part in a pre-surgery evaluation process.
How to discover whether weight loss surgery is covered
If you are interested in weight loss surgery and are an IEHP member, the best way to determine your coverage is to contact IEHP directly.
To find out if you qualify and which procedures might be covered by your insurance plan, you can also consult your doctor or a weight loss surgery facility.
Finally, if you’re serious about losing weight, think about having weight loss surgery. It’s the only method to lose a lot of weight and keep it off permanently. Within two years after having bariatric surgery, patients typically drop 30 to 50 pounds. It’s time to add surgery to your list of options if you’re ready to change.
Does Medical cover weight loss surgery?
Yes, Medi-Cal does cover weight loss surgery in California for patients who meet certain criteria.
How do I qualify for weight loss surgery in California?
To qualify for weight loss surgery in California, you generally must have a BMI (body mass index) of 40 or higher or a BMI of 35 or higher with an obesity-related medical condition, such as diabetes or high blood pressure. You must also have tried other weight loss methods, such as diet and exercise, without success.
What can disqualify you from bariatric surgery?
In addition to BMI and medical history, other factors can disqualify you from bariatric surgery. These may include certain psychological conditions, such as untreated depression or substance abuse, and medical conditions that make surgery too risky, such as severe heart or lung disease.
What is the safest weight loss surgery?
As for the safest weight loss surgery, there is no one-size-fits-all answer to this question. Each type of weight loss surgery has risks and benefits, and the safest option for you depends on your health and medical history.
Common weight loss surgery types include gastric bypass, gastric sleeve, and adjustable gastric banding. Your doctor or surgeon can help determine which weight loss surgery is best for you.