Costs and insurance - weight-loss surgery
Description
Weight-loss surgery and care can be costly. Most health plans cover these surgeries. But finding out the cost before surgery can save you hassle and money afterwards.
What does weight-loss surgery cost?
The cost of weight-loss surgery may vary in different parts of the United States.
Here is the average cost of different types of surgery, without complications:
- Laparoscopic gastric banding can cost around $15,000.
- Gastric bypass surgery can cost around $24,000.
- Sleeve gastrectomy can cost around $18,000 to $20,000.
In general, this cost includes:
- Visits with the weight-loss surgeon before and after surgery, including a physical exam and medical history
- Blood tests before and after weight-loss surgery
- Surgeon fees for the surgery itself
- Fees for the anesthesiologist (the doctor who will use drugs so you will be asleep and feel no pain during surgery)
- Cost of care while you're in the hospital
Serious complications may add an extra cost -- up to many times the cost of surgery.
Other care you may receive can add to the cost. This may include visits with a psychologist, nutritionist, and other specialists.
Most health plans, as well as Medicare and Medicaid, will cover weight-loss surgery. But it is important for you to check to see if your specific plan will cover weight loss surgery.
You may not have insurance, Medicaid, or Medicare coverage at all. In some cases, the health plan or Medicare or Medicaid will not cover the cost. If this is true for you:
- Talk with the business office at both the hospital and your doctor's office. You can ask them about getting a discount and creating a payment plan.
- Talk to the business office weeks or months before your surgery. Do not wait until the last minute.
- Some companies or banks provide loans for surgical care. The business office may have more information.
Talk to your insurance company
If you do have health coverage, you still will need to go through an approval process. This can often be long and complicated.
Even if weight-loss surgery is covered, you may still need to pay part of the bill. Most health plans have you pay part of the cost. These are called copayments, coinsurance, deductibles, or out-of-pocket expenses.
Your insurance company should be able to tell you what costs are covered, and what parts you will need to pay for.
The approval process
Getting approval from your insurance company is called pre-authorization. They may only pay for the surgery if you have certain health problems that can improve after the surgery and weight loss.
Find out exactly what your insurance company will cover ahead of time. Questions you may ask include:
- Is the type of surgery you are having covered? Sometimes, newer methods may not be covered.
- Are there any exclusions to weight-loss surgery in your plan?
- Do your surgeon and hospital have a contract with your health plan?
- If you need physical therapy, will your insurance cover home health nurses or aides, and other services after you go home?
Your health plan will want to know about the following:
- The medical reasons (indications) for weight-loss surgery
- Other medical or emotional problems you have that may make surgery more risky or recovery more difficult
The insurance company will also want to know about past efforts you have made to lose weight.
- Most require you to have joined a weight-loss program that involves diet and exercise, with visits to the dietitian.
- These weight-loss attempts should last for at 3 to 6 months and be supervised by a physician.
The process often begins with a letter from your primary care provider or a bariatric surgeon you have visited. It should describe the medical reasons for surgery and your weight-loss history.
You or your surgeon will need to send a request to your insurance company to pay for your surgery. Also be sure to submit your medical records showing your health problems and past efforts to lose weight.
If your insurance company denies or refuses to cover this surgery, there is an appeals process. Find out why the surgery was denied and submit an appeal.
Reviewed By: John E. Meilahn, MD, Bariatric Surgery, Chestnut Hill Surgical Associates, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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