They say you can’t put a price on good health. That may be true, but it is also true that hospitals and doctors still charge a hefty amount to perform surgery.
DR. CHRISTOPHER MCGOWAN
Dr. Christopher McGowan, MD, a leader in endobariatrics, specializes in non-surgical obesity treatments and is triple-board-certified in Internal Medicine, Gastroenterology, and Obesity Medicine. Renowned for pioneering endoscopic sleeve gastroplasty (ESG) with over 2,000 procedures, his global influence and research contributions define him as a top expert.
Dropping pounds can be an expensive proposition. While on a diet you may be eating less food, but you are likely to pay more for things like a gym membership and working with a dietitian or a nutritionist. If you have tried working out, been on every diet imaginable, and are still in need of losing weight, you could be looking at a much larger expense—bariatric surgery.
What is Bariatric Surgery?
Bariatric surgeries are medical procedures designed to help you lose weight. The most commonly known is a procedure called Roux-en-Y gastric bypass surgery. This surgery involves a surgeon separating the upper portion of your stomach and attaching it to a section of your small intestine. This leaves you with a smaller stomach to prevent you from eating as many calories. Bariatric surgery is for people considered morbidly obese, a condition identified by a body mass index (BMI) over 35. Typical candidates for surgery also exhibit at least one comorbidity such as type 2 diabetes or heart disease.
Other weight loss surgeries are variations on this theme of giving you a stomach with a smaller volume than you had before the operation. If gastric bypass is not for you, a surgery known as sleeve gastrectomy aims to turn your stomach into a small tube or sleeve without rerouting your intestines. Gastric banding, sometimes called lap banding when performed laparoscopically, is another common alternative that restricts the rate at which food can move through your stomach.
Does Insurance Pay for Gastric Bypass?
The answer to the question of whether your insurance company is going to pay for gastric bypass is, “It depends.” Some surgeries are covered, but whether you get coverage will depend on your health condition, your insurance company, and what is covered in your specific plan.
Not all surgeries are created equal, and neither are insurance companies or even insurance plans for that matter. Increasingly, three kinds of bariatric surgery are covered. This includes gastric bypass, gastric banding, and sleeve gastrectomy. These are some of the most commonly performed, well-researched, and consequently most expensive surgeries available. With the passing of the Affordable Care Act, plans sold through the ACA marketplace are required to provide coverage for these types of surgery. Other bariatric procedures such as biliopancreatic diversion, stomach stapling, and duodenal switches are generally not covered by health insurance companies.
Health insurance companies are beginning to change their attitudes toward the cost of weight loss surgery due to the high cost of treating other medical conditions aggravated by obesity. Research has now shown that having a high BMI will dramatically increase your chances of experiencing many medical issues, including:
- type 2 diabetes
- heart disease
- high blood pressure
- osteoarthritis
- depression
- sleep apnea
- infertility
- gastroesophageal reflux disease (GERD)
It may be expensive to foot the bill for a sleeve gastrectomy, but that cost pales in comparison to treating someone for a massive heart attack. This is to say nothing of the long-term costs of conditions like type 2 diabetes. As a result, if you meet the medical criteria for obesity and your doctor determines you already have other risk factors, or even the initial signs of the conditions listed above, your insurance company may consider paying for weight loss surgery if your plan covers it.
Typically, weight loss surgery will only be considered if you have already proven unsuccessful with other attempts to lose weight. Given the expense, and the possibility of complications associated with major abdominal surgery, your doctor is not likely to recommend you as a candidate for bariatric surgery until it is truly considered to be your last resort.
What Makes Gastric Bypass Surgery so Expensive?
It may seem crazy to fork over the cost of a small car for surgery, but major bariatric surgery is a far cry from a quick trip to the doctor’s office. The cost of gastric bypass includes the fees for your bariatric surgeon, a short hospital stay after surgery, follow-up appointments with your doctor, and a nutritionist for several months after surgery.
Your total surgery cost is going to also include the fees from an anesthesiologist and any other specialists who may be called in for your surgery. Depending on the bariatric surgeon you choose and where your procedure is performed, it could be that not everyone in the operating room is covered by your health insurance.
The cost of bariatric surgery is also going to depend on how it is performed. Roux-en-Y gastric bypass surgery and gastric banding can be performed with traditional incisions, or they can be done laparoscopically. The smaller incisions used in a laparoscopic procedure do less damage to the body, but can only be done in certain facilities by specifically trained surgeons. Choosing a laparoscopic procedure will shorten your recovery time, but it may limit your options for providers to choose from.
Will Medicare Pay for Gastric Bypass Surgery?
When it comes to weight loss surgery, Medicaid has your back where traditional insurance coverage may not. Medicaid will cover three different forms of bariatric surgery (gastric bypass, sleeve gastrectomy, and gastric banding) if you meet certain criteria such as having a high enough BMI for your age and gender and at least one comorbidity.
Just having Medicaid is not enough to get you booked for surgery. You may be encouraged to attend six months of a physician-supervised diet program. These programs are designed to track your weight over time to help rule out weight swings or other conditions that could make you a poor candidate for surgery. This can include unresolved problems with binge eating that may not be compatible with your new stomach size after surgery. Living with your new, smaller stomach is going to require a tremendous amount of dietary discipline, and the period of medically supervised dieting is designed to evaluate how well you will do after a potential surgery.
The tipping point for whether you are eligible for surgery or not may come down to the presence of comorbidities. If you have been diagnosed with sleep apnea, high cholesterol, or diabetes, it is more likely you will be recommended for surgery. The prospect of heart disease or complications from diabetes down the road makes the risks and costs of gastric surgery more acceptable for insurance companies.
On the other hand, there are health problems that could disqualify you as a candidate for surgery. The rapid weight loss and caloric restriction in the first weeks after bariatric surgery put a great deal of strain on the body as it tries to adjust. If you have any of several problems with your gastrointestinal tract or existing dietary limitations, your doctor may not recommend you as a candidate for weight loss surgery. A few of the conditions that could disqualify you include:
- malignant cancer
- inflammatory bowel disease
- pancreatitis
- long-term steroid use
What do I do if my Health Insurance Won’t Pay for Bariatric Surgery?
An initial denial of coverage for bariatric surgery may or may not be an insurmountable obstacle to getting your surgery paid for. If your insurance plan explicitly does not cover surgery, you are going to have a nearly impossible fight ahead of you. If, on the other hand, your insurance covers bariatric surgery but you have been denied for specific reasons, you may be able to appeal the decision or ask for a partial payment of surgery costs.
Appealing a denial of coverage for surgery is typically a lengthy process that involves a tremendous amount of documentation and record-keeping. Some bariatric surgeons will help in your appeal by documenting their recommendations and findings about why you would be a good candidate for surgery. You may also need to pull in help from your state’s insurance commissioner if you believe you are being denied coverage on unreasonable grounds.
As extreme as it may sound, changing jobs to get different insurance coverage is also an option.
Bariatric surgery alone may not be enough reason to start working somewhere new, but if you are already on the hunt for new work, keeping a keen eye out for jobs that provide better health coverage may be a route to getting the benefits you need.
This all may seem daunting, but it can take up to three years from first considering weight loss surgery to finally heading to the operating room. This gives you a lot of time to get finances in order, consider switching insurance companies, or even see about changing jobs.
In the event you are going to be completely responsible for the costs of bariatric surgery, there are still alternatives to simply writing a sizable check upfront. Your surgeon’s office may have a person on staff who can help you find financing options. Medical loans are available for many kinds of surgeries, and gastric bypass is certainly on that list. A little shopping around with lenders should land you a set of payment plans to choose from that fit your budget.
Are There Cheaper Alternatives to Bariatric Surgery?
If it feels like you are out of options or you are coming up against a wall trying to work with your insurance company, it may help to know you are not alone. Many people who consider weight loss surgery discover they would be left footing the bill themselves.
Finding out you will be responsible for the cost of bariatric surgery may get you wondering if there is a cheaper alternative to the traditional gastric bypass or lap band. The good news is, that there are several minimally invasive options available that cost a fraction of the price, are nearly as effective at helping you lose weight and keep it off, and have fewer dangerous side effects.
With the average cost of a bariatric surgery generally north of $20,000 depending on the type of surgery you are looking at, it may be a relief to hear there are other options on the market. Some of these non-surgical minimally invasive procedures can be priced from little more than $6,000 and higher. The price alone makes these procedures and programs attractive alternatives to the cost and risk of gastric bypass or a sleeve gastrectomy.
Below are a few of the most compelling alternatives to bariatric surgery that can help you find the freedom you have been seeking in achieving your weight loss goals. The lowered risks associated with some of these minimally invasive, reversible procedures provide even more incentive to investigate these options further.
- Gastric Balloon Placement
Unlike traditional weight loss surgery that alters the volume of your stomach, the ORBERA® Managed Weight Loss Solution uses a saline-filled balloon to occupy most of the volume in your stomach. This leaves you feeling full more quickly, which helps you reduce the amount you eat.
- Endoscopic Sleeve Gastroplasty
Though quite similar to sleeve gastrectomy surgery, ESG is an outpatient procedure using an endoscopic suturing device to sew a portion of your stomach together into a small sleeve. This sleeve is much smaller than your previous stomach volume. The remainder of your stomach is left in place, rather than it being removed as is the case with a sleeve gastrectomy.
- Medical Nutritional Therapy
This last option moves from minimally invasive to not invasive at all. Rather than changing the size of your stomach or the amount of food you can physically fit in your body, medical nutritional therapy is a comprehensive system designed to keep you in direct contact with a team of specialists who can work with you as you find your way to a healthy weight.
At True You Weight Loss, we focus solely on these procedures as an alternative to the risk and costs of weight loss surgery. If you have been running into dead ends in your search for a surgical alternative to weight loss, request a consultation with us today to see if we can help you find the freedom you are looking for.
True You was founded explicitly to help individuals who found that weight loss surgery was not an option for them. Whether the high cost of bariatric surgery proved too much to swallow, or health conditions prevented you from being approved for surgery, alternatives such as ORBERA® provide compelling alternatives to helping you meet your weight loss goals.
Wherever you find yourself in your search for the right answer to chronic struggles with excess body weight, don’t give up. Persistence, and finding the right support, is the key to finding the freedom you have been searching for.
