Is Weight Loss Surgery Covered By Insurance In Canada?

Most medically required surgery in Canada are covered. Weight loss surgery is a major one, and some wonder if it is covered by insurance by the Canadian public health system or private companies. We will carefully explore the answer to the question, “Is weight loss surgery covered by insurance in Canada.”

Is Weight Loss Surgery Covered By Insurance In Canada?

Yes, weight loss surgery is covered by insurance in Canada when you get the right policy. In Canada, weight loss surgery is covered by public provincial health care plans, and the process, criteria, and timelines vary by province, as do wait times. Insurance coverage for weight loss surgery varies depending on the specific province, the type of surgery, the patient’s medical condition, and the insurance plan itself. Some provinces in Canada may offer coverage for weight loss surgeries like gastric bypass, gastric sleeve, or gastric banding when specific medical criteria are met, such as a high body mass index (BMI) or obesity-related health issues.

However, surprisingly, public facilities only account for one-third of all weight loss surgeries in Canada, while private clinics cover the remaining two-thirds. The average time to wait for publicly-funded weight loss surgery in Canada is five years, long for those suffering from weight loss surgery. As such, most of these patients have to take private medical insurance to cover their surgery.

Types Of Weight Loss Surgeries Covered By Public Insurance

The types of weight loss surgeries funded by public insurance in Canada vary depending on the province or territory. Each province has its health insurance program, and coverage for weight loss surgeries can differ.

Some of the common types of weight loss surgeries that may be covered under public insurance in certain provinces or territories include:

• Gastric Bypass (Roux-en-Y)
• Sleeve Gastrectomy
• Gastric Banding (Lap-Band)

It’s essential to note that each province or territory may have specific criteria and eligibility requirements for weight loss surgery coverage. Typically, coverage is considered for individuals with severe obesity (a high body mass index) and those without significant weight loss through other means, like diet and exercise.

Eligibility Requirements For Weight Loss Surgery To Be Covered by Insurance

For Public Insurance Coverage

The eligibility requirements for public insurance coverage vary depending on your province. Each province has its health insurance program and its specific eligibility criteria.

Generally, to be eligible for public insurance coverage in Canada, you must have a BMI between 35 and 40 with weight-responsive medical conditions such as sleep apnea, diabetes, and high blood pressure and a BMI greater than 40 with or without weight-responsive medical conditions. Also, you must be a legal resident of the province or territory where you apply for health insurance. Canadian citizens and permanent residents are typically eligible, but there may be specific rules for newcomers and individuals on temporary visas.

Once you meet the eligibility criteria, you can apply for a provincial health card. This card proves your eligibility for publicly funded healthcare services in that province or territory. Note that there are variations in coverage for specific services or procedures, including weight loss surgeries, prescription drugs, and medical devices.

For Private Insurance Coverage

Different insurers have different specifics you must satisfy to qualify for weight loss surgery. However, individuals with a BMI above a certain threshold may be considered eligible for weight loss surgery. The BMI cutoff can vary, typically around 35-40 or higher.

Some insurers may require evidence that you have tried and failed to achieve significant weight loss through conventional diet, exercise, and medical supervision. Also, obesity-related health conditions, such as sleep apnea, high blood pressure, type 2 diabetes, or other significant health issues, might increase eligibility.

Additionally, some insurers may have age restrictions for weight loss surgery, typically requiring patients to be over a certain age. Many insurance providers require a psychological assessment to ascertain that the patient is mentally prepared for the challenges of weight loss surgery and the necessary lifestyle changes.

The surgery may be covered if deemed medically necessary, as a qualified healthcare professional states. It’s important to note that even if you meet the eligibility requirements, it doesn’t guarantee automatic coverage. Each case is reviewed individually, and the decision ultimately depends on the terms and conditions of your specific insurance policy.

What Are The Possible Risks And Complications Of Weight Loss Surgery

Before considering weight loss surgery, it’s essential to have a thorough discussion with a healthcare team, including the bariatric surgeon and dietitian, about the potential risks, benefits, and expected outcomes.

Some of the possible risks and complications of weight loss surgery include:

Surgical Risks:

Weight loss surgery is a major and similar surgical procedure. There are risks of infection, bleeding, blood clots, and anesthesia-related complications.

Gastrointestinal Issues:

Some individuals may experience complications such as leaks, strictures, or dumping syndrome, which can cause discomfort and require medical intervention.

Gallstones:

Rapid weight loss can increase the likelihood of developing gallstones.

Ulcers:

Peptic ulcers can occur in the stomach or small intestine, leading to pain and discomfort.

Hernias:

Incisional or internal hernias can develop after surgery.

Nutritional Deficiencies:

There is a risk of nutritional deficiencies due to reduced nutrient absorption after weight loss surgery. Regular monitoring and supplementation may be necessary to prevent deficiencies.

Psychological Considerations:

Weight loss surgery can have psychological implications, and individuals should be prepared for the emotional challenges that may arise during the weight loss journey.

What Are The Possible Benefits Of Weight Loss Surgery

Here are some of the possible benefits of weight loss surgery:

Substantial Weight Loss:

Weight loss surgery can lead to significant and sustained weight loss, which reduces the risk of obesity-related health conditions.

Improved Health Conditions:

Individuals experience improvements or remission of obesity-related health conditions such as high cholesterol, sleep apnea, type 2 diabetes, and high blood pressure.

Psychological and Emotional Benefits:

Many patients report improved self-esteem and mental health as they lose weight and witness positive body and health changes.

Sustainable Long-Term Results:

With proper adherence to recommended lifestyle changes, weight loss surgery can provide lasting results and help maintain a healthier weight over the long term.

Is Weight Loss Surgery A Cosmetic Or Medical Procedure?

Weight loss surgery is primarily considered a medical procedure rather than a cosmetic one. The main aim of weight loss surgery is to treat severe obesity and its associated health conditions. It is designed to help individuals struggling with significant excess weight and who have not been able to achieve sustainable weight loss through other means, such as diet, exercise, or medication.

What Are The Pre-Surgery Preparation Guidelines

Pre-surgery preparation is crucial to weight loss surgery to ensure a safe and successful procedure and recovery. If you are considering weight loss surgery, here are some general pre-surgery preparation guidelines that you may need to follow:

Medical Evaluation:

Undergo a comprehensive evaluation with your bariatric surgeon and healthcare team. This evaluation will assess your overall health, medical history, and if there are any existing health conditions to determine if you are a suitable candidate for weight loss surgery.

Educational Seminars:

Attend educational seminars or counselling sessions provided by the bariatric surgery center. These sessions will help you understand the surgery, potential risks, benefits, and the necessary lifestyle changes after the procedure.

Weight Loss and Nutrition:

Some bariatric surgery programs may require you to lose weight before the surgery. Follow any specific dietary guidelines your healthcare team provides to optimize your health before the procedure.

Psychological Evaluation:

Undergo a psychological evaluation to assess your emotional readiness for the surgery and the following lifestyle changes. This evaluation can help identify any underlying emotional issues that must be addressed.

Medication Review:

Discuss all current medications, including prescriptions, over-the-counter medications, and supplements, with your healthcare team. Some medicines may need to be adjusted or temporarily discontinued before the surgery.

Fasting Instructions:

Follow any fasting instructions provided by your healthcare team. Typically, you must fast for a certain period before the surgery to avoid complications during anesthesia.

Pre-operative Diet:

Some weight loss surgery programs may require you to follow a specific pre-operative diet to shrink your liver and reduce the risk of complications during surgery. This diet may involve consuming liquid or low-calorie foods for a few days before the procedure.

Common Lifestyle Changes After Surgery

After weight loss surgery, adopting and maintaining specific lifestyle changes is crucial to achieve successful outcomes and long-term weight loss. These changes support your health, aid in weight management, and prevent potential complications. The specific lifestyle changes vary, and it depends on the specific type of weight loss surgery you undergo, but some common ones include:

Dietary Changes:

Following weight loss surgery, your diet must be gradually reintroduced and modified. Typically, you will start with a liquid or pureed diet and then advance to soft foods before incorporating regular solid foods. Portion control and eating small, frequent meals are essential to prevent overeating and aid digestion.

Hydration:

Drinking adequate water throughout the day is essential after weight loss surgery. However, you may need to avoid drinking liquids with meals to prevent overfilling your small stomach pouch. Staying hydrated is vital for digestion.

Physical Activity:

Regular physical activity is essential for maintaining weight loss, improving overall health, and preventing muscle loss after surgery. Start with light exercises as your healthcare team advises, gradually increasing the intensity and duration.

Vitamin and Mineral Supplementation:

Nutrient absorption may be reduced after weight loss surgery. You will likely need to take vitamin and mineral supplements to prevent nutritional deficiencies, including vitamins B12, D, iron, calcium, and others. Follow your healthcare team’s recommendations for supplementation.

Avoiding Problematic Foods:

Some foods may be more difficult to tolerate after weight loss surgery due to changes in digestion. High-fat, high-sugar, and carbonated beverages are often avoided, as they can cause discomfort or dumping syndrome.

Regular Medical Follow-up:

Attend regular follow-up appointments with your bariatric surgeon and healthcare team. They will monitor your progress, address concerns, and adjust your post-surgery plan.

Avoiding Smoking and Alcohol:

Smoking and excessive alcohol consumption increase the risk of complications and hinder weight loss. It’s essential to avoid or limit these habits post-surgery.

People Also Ask:

How Do I Get Approved For Weight-Loss Surgery In Canada?

To get approved for weight loss surgery in Canada, you must be morbidly obese with a body mass index (BMI) of at least 40. Also, if you are obese with a BMI over 35 and suffering from at least one medical problem related to obesity, such as diabetes, heart disease, and breathing problem, you will be approved for weight loss surgery. You can get covered by OHIP or private insurance if you are doing it in a private hospital.

Does Canada Pay For Weight-Loss Surgery?

The public health system can cover your weight loss surgery depending on the province and whether you meet the criteria. For instance, gastric bypass surgery in Ontario is covered by OHIP if you meet their qualifications.

What Excludes You From Weight-Loss Surgery?

You will be excluded from weight loss surgery if you have an inflammatory disease or gastrointestinal tract infections, such as Crohn’s disease, ulcers, or severe esophagitis. You will be considered unfit for the surgery if you have severe lung or heart disease.

Conclusion

Weight loss surgery is covered by insurance in Canada when it is considered medically necessary and when there is evidence that other weight loss methods have failed to produce the desired results.

The public health system and private insurance can cover weight loss surgery as long as you meet their requirements. If you are getting private insurance for your weight loss, carefully review the policy and ensure it fits your need so that you won’t spend much from out of pocket.