Does Aetna Cover Bariatric Surgery?

Which Procedures Does Aetna Cover?

Embarking on the journey to a healthier lifestyle through bariatric surgery can be a life-changing decision. For many individuals struggling with obesity, this surgical intervention offers a promising solution to achieve long-term weight loss and improve overall health. 

However, a critical aspect of this transformative journey is understanding the financial aspects, such as insurance coverage. In this article, we will describe Aetna’s coverage, the specific surgeries covered, and the steps to gain insurance approval for bariatric surgery.

Does Aetna Cover Bariatric Surgery?

Aetna, one of the leading health insurance providers in the United States, recognizes the importance of bariatric surgery in addressing obesity-related health issues. However, the coverage for bariatric surgery may vary based on the specific plan and policy. 

It is crucial for individuals considering such procedures to carefully review their Aetna insurance policy documents and communicate directly with Aetna representatives to determine their coverage eligibility.

Aetna Approval - Bariatric Surgery

Which Surgeries Does Aetna Cover?

Aetna generally covers a range of bariatric surgeries, understanding that individuals may require different procedures based on their unique health conditions and weight loss goals. Some of the common bariatric surgeries covered by Aetna may include:

  • Gastric Bypass Surgery: A procedure that involves creating a small stomach pouch and rerouting the small intestine to limit the amount of food one can consume and absorb.
    • Out-of-pocket costs for Gastric Bypass typically range from $5,000-8,000.
  • Sleeve Gastrectomy: This surgery removes a portion of the stomach to create a smaller, sleeve-shaped stomach, reducing the amount of food it can hold.
  • Adjustable Gastric Banding (Lap-Band): A procedure where a band is placed around the upper part of the stomach to create a smaller pouch, restricting food intake.

It’s important to note that coverage details may vary, and some policies might require specific criteria to be met before approving certain surgeries. Additionally, coverage may extend to pre-operative and post-operative care, including consultations, nutritional counseling, and follow-up appointments.

How to Get Approved for Bariatric Surgery?

Navigating the approval process for bariatric surgery with Aetna involves several steps. Here is a guide to help individuals seeking coverage for their weight loss journey:

  • Understand Your Insurance Policy: The first and most crucial step is reviewing your Aetna insurance policy documents thoroughly. Identify the specific terms and conditions related to bariatric surgery coverage, including any exclusions or requirements.
  • Verify Eligibility: Contact Aetna directly to verify your eligibility for bariatric surgery coverage. Insurance representatives can provide information on your policy’s coverage limits, requirements, and necessary documentation.
  • Consult with Your Healthcare Team: Schedule consultations with your healthcare team, including your primary care physician and a qualified bariatric surgeon. They can assess your health status, determine if bariatric surgery is medically necessary, and provide the documentation for insurance approval.
  • Follow Aetna’s Requirements: Aetna may have specific requirements for coverage approval, such as evidence of previous weight loss attempts, documentation of co-morbidities related to obesity, or participation in a medically supervised weight loss program. Complying with these requirements can increase the likelihood of approval.
  • Submit Necessary Documentation: Prepare and submit all required documentation, including medical records, physician recommendations, and any other information specified by Aetna. Clear and comprehensive documentation strengthens your case for coverage approval.
  • Appeal if Necessary: In some cases, coverage may be initially denied. If this occurs, keep hope. Work with your healthcare team to appeal the decision, provide additional information, or address any concerns Aetna raises.


Embarking on the path to bariatric surgery with Aetna coverage requires careful navigation through policy details, eligibility criteria, and approval. 

Understanding the coverage provided, the surgeries included, and the necessary steps to gain approval is essential for a successful and financially manageable weight loss journey. 

Individuals considering bariatric surgery should proactively engage with their healthcare team and insurance provider to ensure a smooth process toward achieving a healthier and more fulfilling life.

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