Saturday, April 13, 2024

How Much Is Bariatric Surgery Without Insurance

The Hidden Cost Of Obesity


Obesity is linked to a higher cost of living, including medical costs. People who are obese often spend more on medical care, medications, and insurance. Obesity is linked to several chronic health conditions, including heart disease, type 2 diabetes, and high blood pressure, which can increase healthcare costs.

Dr. Peter Nau, a bariatric surgeon at the University of Iowa, says, While weight loss surgery certainly isnt cheap, its far more expensive to not have the surgery, otherwise insurance wouldnt pay for it. The insurance companies save money since patients are healthier.

Nau also notes that obesity can lower income and productivity. The absenteeism associated with obesity is huge, he says. Obesity is a significant cause of loss of work and not being productive while you are at work.

Plus, if a person has type 2 diabetes, and youre on 100 units of insulin and two oral medications, it can be financially devastating, depending on how much they have to pay out of pocket.

While surgery may not cure their diabetes, to take them from 100 units of insulin and two oral medications to just one medication can make a huge difference in their cost, Nau says.

suggest that people lose 15% to 30% of their total body weight, though some of it is regained.

Research from 2017 suggests that people may lose 60% to 70% of their excess weight.

The Cost Of Gastric Sleeve Surgery

For most individuals, the cost of gastric sleeve surgery is determined by their insurance plan. At BMI of Texas, our services are in-network with most major insurance providers. We also provide additional, employer-based coverage to many local employers in the San Antonio area. Your exact insurance plan will determine what portion, if any, of your hospital bill will need to be paid out-of-pocket.

The cost of gastric sleeve surgery can vary dramatically around the country, as well. Here in San Antonio, we are proud to offer the highest-quality services at a fraction of the cost of the exact same surgery in Los Angeles, New York, and other metropolitan areas in Texas.

Weight Loss Surgery Costs At St Louis Bariatrics

We are dedicated to helping self-pay patients in St. Louis find weight loss success, even if your insurance does not cover the cost of bariatric surgery. We offer a number of payment plans and financing options for patients who are interested in a gastric sleeve, gastric bypass or gastric banding, as well as non-surgical weight loss procedures such as a gastric balloon or Endoscopic Sleeve Gastroplasty .

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What Happens If Coverage Is Refused

  • If there is just a tiny percentage of coverage, you can file an appeal. This letter should include the following information:
  • Explain why you believe you should cover your surgery.
  • A formal request for an explanation as to why they were denied coverage or underpaid.
  • Ask for a copy of a specific policy or benefits booklet statement that explains why your coverage is limited or denied.
  • A duplicate of the rejection notification.
  • A copy of your doctors letter of pre-approval request.
  • How Much Does Bariatric Surgery Cost With Or Without Insurance

    How to Pay for Bariatric Surgery Without Insurance

    Bariatric Surgery Tim Garey

    Obesity and its related disorders have haunted the American people for decades. Clinical obesity, a condition that affects one out of every six Americans, brings a host of potentially life-threatening conditions in its wake. Cost aside, extreme weight loss surgery would seem to be a miraculous solution to the problem. The evidence to date suggests that surgery can improve or cure up to thirty obesity-related illnesses, nearly all of which have been on the rise in recent decades. The expense, however, should not be taken lightly. Bariatric surgery costs go beyond the relatively simple realm of dollars and cents and embrace peripheral costs, unexpected costs, and even the hard-to-quantify costs of risk versus reward assessments. The following is a guide to bariatric surgery costs with or without insurance, its associated risks, and other factors that will help you decide whether weight loss surgery is worth having.

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    Why Does Bariatric Surgery Price Vary So Much

    One of the main reasons for the rather wide divide in the price ranges of both gastric sleeve and gastric bypass procedures for weight-loss, has much to do with where the surgery is performed. For example, the gastric bypass surgery cost in California differs from the gastric bypass cost in Mexicoor even Montana.

    But, its important to note, that while it may be tempting to immediately opt for the weight-loss surgery thats most cost-effective, its better to take the lead from an expert who is board-certified, with extensive surgical experience when deciding which approach is best for you.

    Factors Contributing To Surgery Cost

    Bariatric surgery costs money, but exactly how much will be determined on a case-by-case basis and usually depends on a number of factors. What type of surgery youve chosen to undergo will be the dominating factor. A sleeve gastrectomy or gastric binding might have a direct cost of around $15,000, while a more invasive procedure, such as Roux-en-Y will often cost something more like $21,000. Other important factors affecting the cost will be the location of the surgerythe Mayo Clinic will obviously charge more than the county hospitaland time spent in the hospital in recovery. These costs vary widely not just from one facility to another but often from one patient to another. Your best bet is to get a written estimate of your specific surgery cost before agreeing to the procedure.

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    Types Of Weight Loss Surgery

    Before discussing the costs, its worth clarifying just what is meant by the term. Bariatric surgery is a broad field, and many different surgical procedures are available. Each procedure is unique, and each will have its own laundry list of direct costs, related expenses, and risk profiles. The surgery basically comes in two types: one kind restricts your food intake, and the other interferes with your bodys ability to absorb nutrients from the food you eat. The former, often referred to as lap band surgery or stomach stapling, is more commonly performed. This category includes gastric bypass, adjustable banding of the stomach, and vertical banding. The direct costs usually depend on which procedure you choose, where you have it done, and the expertise of your surgeon. As a rule, however, you can expect the bill to fall in about the $20,000 to $35,000 range estimated by the National Institute of Diabetes and Digestive and Kidney Diseases.

    Getting Your Insurance To Pay For Weight Loss Surgery

    Bariatric Surgery: Pre op diet and getting surgery without insurance!

    Most major insurance companies will require:

    • Proof that surgery or medical intervention is medically necessary. Your surgeon can help provide your medical history and documentation of your weight-related health problems.
    • Participation in a physician-supervised diet program. You may be required to successfully complete a 6-month weight-loss program before approval is granted. Medicare does not require this 6-month program, but you may be encouraged to participate anyway. This type of diet program involves monthly visits to your doctor or bariatric surgeon’s office for 6 months. The insurance companies arenât trying to find out if you can lose weight through dieting. In fact, most insurance companies require that the patient’s weight be stable during this time — with no up-and-down fluctuations — or you may be denied coverage. They want you to demonstrate over the 6 months prior to surgery that you can commit to lifestyle changes youâll need to make forever after your weight loss surgery.
    • A psychological evaluation. This is to make sure that you understand weight loss surgery and the impact it will have on your lifestyle. The psychological evaluation also checks for untreated binge eating or any other psychological issues.
    • A nutritional evaluation. You will work one-on-one with a nutritionist to outline specific dietary changes and habits that need to be changed.

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    How To Get Started With Surgical Weight Loss

    To get started with surgical weight loss, youll want to do research and talk with at least two surgeons. If you can, consider attending an in-person or online seminar to learn more about the process.

    Also, youll need to see if you meet the criteria of your insurance coverage. This might include having a specific body mass index and obesity-related conditions.

    Check to see which hospitals your plan covers. You can also find out whether you need a referral from your primary care physician and provide information regarding your medical history. You may also need to provide evidence that other weight loss methods were not effective.

    Is It Worth It To Get A Gastric Bypass

    For some patients, having a bariatric procedure, like gastric bypass, is worth it. For a committed patient, weight loss surgery is an effective tool for losing weight. It has also shown to be effective at reducing the impact of many obesity-related conditions such as type 2 diabetes, sleep apnoea, and heart disease.

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    What Is The Average Cost Of Bariatric Surgery

    The costs of bariatric surgery vary greatly depending on which medical facility you select, the procedure that is performed, and the coverage options offered by your insurance, if any. If you plan to pay out of pocket, a roux-en-Y gastric bypass costs approximately $19,000 while a sleeve gastrectomy or LAP-BAND surgery averages $17,000 to 18,000. Both gastric bypass cost and gastric sleeve cost without insurance can be cost prohibitive for most. Revision bariatric surgery costs can vary, but may range between $10,000 and $15,000 depending on the procedure in use. Even with insurance, out-of-pocket costs can be expensive.

    United States: Covered If Your Plan Includes Bariatric Surgery


    In the U.S., gastric bypass is covered under any plan that includes weight loss surgery.

    How Do You Know If Your Insurance Includes Weight Loss Surgery?

    It varies based on how you get your health insurance:

    • Individual/Family Plans & Small Group Plans Obamacare requires that many states cover weight loss surgery.
    • Large Group Plans it is 100% up to the company whether the chosen benefits plan includes bariatric surgery. Ask someone in the HR department or contact your insurance company to see whether its covered.
    • Medicare & Medicaid both of the federally sponsored plans cover gastric bypass surgery, but not all surgeons accept Medicare and Medicaid.

    If Your Policy Covers It: Ask for a Free Insurance Check

    Most surgical practices will check your insurance benefits for free. Importantly, theyll normally do it quickly since they have a staff experienced in dealing with insurance companies.

    Instead of doing your own research, reach out to local surgeons office to check your insurance benefits.

    The below are average out-of-pocket gastric bypass costs if you have insurance:

    See below for assumptions:

    • Zero dollars paid towards your calendar year deductible for other services
    • The were calculated with special formulas that are based off of average plan designs from Kaiser Family Foundations Annual Employer Health Benefits Survey

    If Your Policy Does NOT Cover It: Seek Partial Coverage

    • Cardiology exam
    • Psychological exam

    The U.S. Insurance Approval Process

    • BMI of 40+ OR

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    Government Aid For Weight Loss Surgery Costs

    The federal government can help pay for procedures for qualified patients under the Medicaid and Medicare programs. Both programs have eligibility restrictions, in addition to an application process and waiting period.

    • Medicaid provides health insurance to low-income individuals, and will cover gastric bypass surgery in certain extreme cases. Many requirements must be met in order for Medicaid to cover weight loss programs and surgery, including medical proof that you meet certain weight qualifications and have tried other methods to lose weight.
    • Medicare covers bariatric surgery for individuals who meet specific criteria related to morbid obesity. You will still have to meet your deductibles before Medicare will pay, and you may be responsible for copays for follow-up visits after your procedure.

    If You Get Your Insurance Through Your Job

    If your work-provided insurance coverage does not include bariatric surgery, this might be an opportunity for you to enact change.

    Call HR and ask why theres no coverage for bariatric surgery. Prepare ahead of time so you can gather evidence that shows the health benefits of surgeries like the gastric sleeve. Having surgery can change your life for the better and make you more productive at work.

    While results are not guaranteed, dont worry you should not lose all hope if you lose coverage for your procedure.

    Believe it or not, people have bariatric surgery without insurance, and they are not all swimming in pools of gold coins.

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    Should I Consider Going To Mexico For Bariatric Surgery

    Over the past 10-15 years as insurance plans have changed, medical tourism has become increasingly popular for a host of elective surgeries when patients dont have insurance coverage for their desired procedure. While this may play out favorably for some patients, it rarely works well for bariatric surgery patients. One reason is that medical tourism is more feasible for procedures that do not require preoperative education and ongoing post-operative support relationships, which bariatric surgery does. Saving a few dollars cannot begin to compare with the increased risk of a poor surgical outcome and the absence of a long-term support relationship. You can always make more money, but you only get one life to live.

    Through the years we have heard many sad and frightening stories from patients who went out of the US to a non-MBSAQIP and non-FDA regulated country just save a few dollars. Many unfortunately found themselves with otherwise preventable complications and ongoing problems, which were compounded by the fact that they didnt have a relationship with a bariatric surgeon upon their return to get them through it. If a complication were to occur or additional long-term needs were to arise , the cost of revision, repair or establishing the bariatric support relationship to help the patient through this usually far outweighs any meager initial savings. For bariatric surgery, both the financial and health risk associated with this approach can be substantial.

    Let Us Be A Part Of Your Weight Loss Journey

    Bariatric Surgery: What to Expect with Weight Loss and Whole Health Improvement

    If you suffer from obesity, we want you to know that youre not alone. Millions of people struggle with losing unwanted weight and keeping it off long-term. We want to help you level the playing field. If youve tried everything you can think of every fad diet or exercise program out there and you still havent seen the results you expected, it might be time to consider weight loss surgery.

    Our patients are proof that bariatric procedures can be the first step in a dramatic, life-changing journey. So, whether you have health insurance or not, contact our friendly office staff today and see how we can help you.

    This page was medically reviewed by Dr. Joshua Long, MD, MBA, FACS, FASMBS. Dr. Long is a double-board-certified bariatric surgeon and bariatric medical director for Parker Adventist Hospital.Page Updated: December 16th, 2020

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    Who Administers Your Anesthesia

    General anesthesia is necessary for a lap band procedure and can be provided by either a nurse anesthetist or an anesthesiologist . Ask your surgeon if a CRNA may provide your anesthetic if youre concerned about keeping costs down. Some surgeons prefer the experience of an MD.

    Youll be required to pay for the associated supplies as well as anyone else helping with your anesthesia, in addition to the charge for your anesthesia physician .

    Invest In Your Health

    The price of weight loss surgery can seem daunting, especially if you dont have insurance coverage for it. But, the price of suffering with obesity, ruined health, and limited quality of life is so much higher that it does not even come close to comparing. Today, you need to ask yourself how much you are willing to invest in your health. Although the costs may appear steep at first glance, weight loss surgery can actually help you save money, save your health, and save your life in the long run.

    On average people who suffer from obesity pay 81% more for healthcare. This comes in the form of higher insurance deductibles, more prescription drugs, and more medical bills. Aside from lowering these costs, weight loss surgery can help you feel healthier and can give you the energy to live a happier, more active, and more fulfilling life.

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    Cost With Private Insurance:

    The assessment program and surgeons fees at Mercy Bariatrics depends on which procedure you choose and ranges between $4500 $6000. This also includes initial aftercare and our Success Habits training module. Your health fund and medicare will only cover a portion of this .

    There will also be an out of pocket expense for the Anaesthetist and Surgical Assistant . Full payment, to cover these fees are required prior to all surgery.

    The total out of pocket expenses are typically between $5800 $6800 depending on your procedure, insurance company and policy.

    The out of pocket costs for this surgery are significant, and there are several payment options available to you. There are companies who provide credit for surgical procedures, and accessing your superannuation is another alternative. Our business manager will be very happy to answer any queries you have regarding these options.

    If you decide to proceed, we will provide you with an individualised and complete estimate for the surgical fee and bariatric program. Please contact us.

    Patients can apply to have a portion of their superannuation funds released on medical grounds to cover vital and life saving surgery including Bariatric Surgery to cover the out of pocket costs or even the total cost of surgery if uninsured.

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