The Journal of surgical research · 2026
Insurance Coverage for Endoscopic Bariatric Therapies in 2026: Analyses of Top Insurers in the US and Internal Validation.
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Garcia-Corella Jose, Shah Sagar, Okafor Cynthia, Bechenati Dima, Arif Yousif, Bahdi Firas, Villarruel Elizza, Larios Kelsy, Alhanaee Manar, Thaker Adarsh, Rosenthal Raul J, Muthusamy V Raman, Issa Danny
Аннотация
INTRODUCTION: Though endoscopic bariatric therapies (EBTs) have proven to be safe and effective treatments for weight loss, they remain underutilized. Lack of insurance coverage is thought to be a primary contributing factor to this issue. To further characterize the landscape of insurance coverage for EBT, we analyzed insurance policy documentation relevant to EBT for adults in the United States.
MATERIALS AND METHODS: Policies from the largest 25 health insurances were retrieved and analyzed on the coverage of endoscopic procedures for obesity treatment, particularly primary and revisional EBT. Coverage from these insurers was compared to coverage for EBT of patients referred to our endobariatric clinic, at a large urban tertiary-care academic center.
RESULTS: Of the policies analyzed, only one included coverage for EBT procedures. While 40% of insurers failed to mention any form of EBT as an option, 56% of insurers classified primary EBT as investigational and 52% classified revisional therapy as investigational/unproven. Meanwhile, 24 (96%) insurers provided coverage for bariatric surgery and 16 (70%) did so for revisional surgery. Internal analysis showed 124 (70%) of patients referred for EBT received insurance coverage for a procedure, with an increased approval of revisional procedures when compared to primary [23 primary EBT (19%) + 101 revisional EBT (81%)]. No clinical, demographic, or procedural characteristics were found to predict a higher likelihood of approval, though there was a trend toward increased percentage of cost coverage for patients with diabetes. Cost analysis showed payors covered significantly larger proportions of revisional EBT than primary ESG (88.3% versus 75.9%, P = 0.05).
CONCLUSIONS: As of December 2025, insurance policies on EBTs are not reflective of the data available for EBT. Lack of coverage in these policies contributes to an underuse of these safe, minimally invasive, and effective treatments for weight loss. Real-world data show slightly better yet far from optimal coverage. Inclusion of evidence-based, standardized criteria is critically needed to provide a better access to patients and appropriate imbursement for endoscopists.
MATERIALS AND METHODS: Policies from the largest 25 health insurances were retrieved and analyzed on the coverage of endoscopic procedures for obesity treatment, particularly primary and revisional EBT. Coverage from these insurers was compared to coverage for EBT of patients referred to our endobariatric clinic, at a large urban tertiary-care academic center.
RESULTS: Of the policies analyzed, only one included coverage for EBT procedures. While 40% of insurers failed to mention any form of EBT as an option, 56% of insurers classified primary EBT as investigational and 52% classified revisional therapy as investigational/unproven. Meanwhile, 24 (96%) insurers provided coverage for bariatric surgery and 16 (70%) did so for revisional surgery. Internal analysis showed 124 (70%) of patients referred for EBT received insurance coverage for a procedure, with an increased approval of revisional procedures when compared to primary [23 primary EBT (19%) + 101 revisional EBT (81%)]. No clinical, demographic, or procedural characteristics were found to predict a higher likelihood of approval, though there was a trend toward increased percentage of cost coverage for patients with diabetes. Cost analysis showed payors covered significantly larger proportions of revisional EBT than primary ESG (88.3% versus 75.9%, P = 0.05).
CONCLUSIONS: As of December 2025, insurance policies on EBTs are not reflective of the data available for EBT. Lack of coverage in these policies contributes to an underuse of these safe, minimally invasive, and effective treatments for weight loss. Real-world data show slightly better yet far from optimal coverage. Inclusion of evidence-based, standardized criteria is critically needed to provide a better access to patients and appropriate imbursement for endoscopists.