Weight Loss Surgery Cost

Morbid obesity can be a challenging condition to treat, and many patients find that bariatric surgery is their only option for reaching a healthy weight. The two most common types of bariatric surgery include gastric bypass surgery and LAP-BAND surgery.

When deciding whether to have bariatric surgery, one of the main factors you will have to consider is the cost of this procedure. Be sure that you fully understand the associated financial obligations so that the stress of paying for surgery does not interfere with your recovery.

Bariatric Surgery Costs

If you are planning on having bariatric surgery, expect to spend a total of at least $25,000. This cost includes fees for:

  • anesthesia
  • hospital stay
  • lab work
  • miscellaneous services
  • surgery
  • X-rays.

Medical Insurance

For some patients, medical insurance will cover the cost of bariatric surgery. Laws have been established in many states that force insurance companies to offer benefits for medically necessary weight loss surgery. Unfortunately, many insurance companies are still reluctant to cover weight loss procedures. In most cases, getting bariatric surgery covered by insurance is a long and complicated process.

Proving Your Surgery is Medically Necessary

To get insurance coverage for bariatric surgery, you will need to prove that the procedure is truly medically necessary. The National Institute of Health (NIH) has specific criteria to help determine if patients really need bariatric surgery for health reasons.

According to the NIH’s stipulations, bariatric surgery is considered medically necessary by most insurance companies if you:

  • are morbidly obese and have a body mass index (BMI) of 40 or higher
  • are stable both emotionally and psychologically
  • have been morbidly obese for at least five years
  • have other life-threatening conditions (co-morbidities) such as heart disease, diabetes or hypertension
  • have tried unsuccessfully to lose weight by other methods for at least two years.

Your doctor can verify for insurance companies that you comply with the above NIH criteria. Other medically significant information to give to your insurance company includes:

  • any alcohol or substance abuse history
  • gastrointestinal disease
  • kidney disease
  • liver disorders
  • thyroid test results.

Getting Approved

To increase your chances of getting insurance approval and reducing the cost of bariatric surgery, get your doctor involved in the process. The support of your doctor, especially with an obesity surgery referral, will give you more credibility with your insurance company. During the approval process, it also helps to:

  • Document visits to doctors, diet centers, fitness programs, weight loss programs and all other obesity-related appointments.
  • Read and understand your insurance company’s “certificate of coverage.”
  • Save all receipts related to obesity management.

Second Chances

If you are denied coverage for weight loss surgery, you can still make a successful appeal. The more quickly you appeal, the better your chances of getting some or all of your bariatric surgery costs covered. Your “certificate of coverage” will tell you if there is any limit on the number of times you are allowed to appeal.

Financing

If you are denied insurance coverage after appealing, you still have options to help manage the cost of bariatric surgery. Financing is now available though many financial lenders for this type of procedure. Your surgeon may even be able to help you find a financial program and payment plan to fit your lifestyle and budget.

Resources

Einstein Medical (2006). Cost of Bariatric Surgery. Retrieved April 20, 2008, from the DocShop.com Web site.

Obesity Surgery Centers (2007). Insurance Coverage for Gastric Bypass Surgery. Retrieved April 20, 2008, from the Obesity Surgery Centers Web site.