A Look At the Cost of Weight Loss Surgery
Weight loss surgery is expensive, with the average cost of a gastric bypass ranging from $18,000 to $22,000, and the cost of adjustable gastric banding running as high as $17,000 to $30,000. The variation in prices usually is due to the differences in the fees charged in urban areas and less densely populated places.
When you pay your bill for bariatric surgery, you’re paying for a variety of services, including the use of the hospital, the surgeon’s fee, and the anesthesia. Post-operative costs will also emerge, consisting of diet and fitness plans, nutritional supplements, and behavior modification therapy.
In addition, many people seek cosmetic surgery after they have lost the desired amount of weight. These procedures often include body contouring surgeries, facelift, breast augmentation or breast lift, liposuction, and abdominoplasty.
If you are seeking insurance coverage for weight loss surgery, be aware that coverage is different from state to state, and not all insurance providers offer it. Some insurance carriers will pay 100% of the bill; others that do handle weight loss surgery pay 80% of the “customary and usual” costs of the surgery – costs that are determined by the insurance company.
Medicare will cover three types of weight loss surgery:
- The Roux-en-Y bypass – Uses surgical staples to make a small pouch in the stomach, which is connected to the bowel by a piece of the small intestine, bypassing most of the stomach.
- Open and laparoscopic biliopancreatic diversions – In these surgeries, a large amount of small intestine is bypassed, and digestive juices are diverted to the lower part of the intestine.
- Laparoscopic adjustable gastric banding – An adjustable band is inserted into the abdomen to pinch off a small piece of the stomach.
To be considered eligible for Medicare coverage, you must participate in a six-month medically supervised weight loss program, either with your bariatric surgeon or your primary care physician. At present, Medicare beneficiaries may be considered for weight loss surgery if they have a body mass index (BMI) of 35, and at least one obesity-related health condition, such as diabetes or heart disease.
However, Medicare requires that the weight loss surgery take place at a medical center designated as a Center of Excellence by the American Society for Metabolic and Bariatric Surgery or certified a Level 1 Bariatric Surgery Center by the American College of Surgeons.
Medicare does not require patients to go through pre-certification or pre-authorization in order to be approved for surgery.
Medicaid covers weight loss surgery varies on a state-by-state basis.
Currently, a number of private insurance companies will cover weight loss surgery if your primary care doctor informs them that the surgery is medically necessary. In addition, your doctor must also provide a range of detailed medical documentation to support this claim.
A letter of medical necessity, from your weight loss surgeon and your primary care physician, is required by most insurance companies. The following information should be included in the letter:
- Your height, weight history and BMI
- A complete description of your obesity-related health conditions, including records of treatment. Such conditions may include high blood pressure, diabetes, heart and blood vessel disease, sleep apnea, gastroesophageal reflux, arthritis and high cholesterol.
- A history of your previous dieting efforts
- A description of how the obesity affects your daily activities
- A history of exercise programs you have participated in, including receipts for gym or health club membership
- Your current medications
If you are trying to get insurance coverage for your weight loss surgery, you must collect documentation and letters from all health care professionals who have treated you for obesity-related health conditions. Depending on your insurer, you may also need to get a nutritional consultation and a psychological evaluation. Your surgeon can give you referrals for these visits.
When it comes to financing, a number of bariatric physicians and plastic surgeons offer payment plans.
If you have tried unsuccessfully to get insurance coverage for your weight loss surgery, you can appeal the decision. It’s important that you do this immediately after receiving the denial.
Keep in mind that your insurer is showing good financial sense when approving coverage for your weight loss surgery. Once the weight is lost, the cost of medications for conditions like diabetes and high blood pressure will drop significantly. In fact, many people discover that their blood sugar and blood pressure levels return to normal following weight loss, and medications are no longer needed.