The General Cost of Gastric Bypass, LAP-BAND®, and Other Bariatric Surgery
The cost of bariatric weight loss surgery is usually at least $25,000. The cost of surgery includes the following fees:
• Hospital fees
• Surgeon fees
• Anesthesia fees
• Lab and X-ray fees
• Miscellaneous fees
Although insurance companies are slowly beginning to acknowledge the fact that bariatric weight loss surgery can actually save them money in the long run by preventing future medical issues, most companies still balk when it comes to the idea of covering the cost of LAP-BAND® or gastric bypass surgery for obesity. Convincing insurance providers that bariatric surgery is medically necessary is likely to be the biggest obstacle patients face. It is important that patients understand the insurance approval process and play an active role in pursuing coverage for the cost of bariatric surgery.
Laws have been establisted in many states that require insurance companies to provide benefits for bariatric surgery when a patient meets the criteria of the National Institutes of Health (NIH). However, potential bariatric surgery patients should still prepare themselves for what is commonly a lengthy and complicated approval process. The best chance for acquiring insurance coverage for the cost of LAP-BAND® and gastric bypass surgery comes from working diligently in cooperation with your bariatric surgeon and other professionals.
There several helpful things that you can do to make the insurance approval process easier. Following the steps below you may be able to increase your chances of being approved for bariatric surgery coverage.
• It is imperative that you read and understand your insurance provider’s "certificate of coverage." You can obtain it from your insurance company directly or from your employer’s benefits contract.
• Get a bariatric surgery referral from your doctor. You must have your physician’s full support.
• Save all of your receipts and always keep accurate, detailed records.
• Carefully document each visit you make to doctors and other healthcare professionals for obesity-related issues. In addition to doctor’s appointments, this includes visits to diet centers, fitness clubs, and weight loss programs.
The lengthy authorization process will begin when your bariatric surgeon sends your primary care physician a letter asking him or her to verify the "medical necessity" of your surgery for obesity. Your doctor can establish this by proving that any of the following apply to you:
• You are morbidly obese with a BMI (body mass index) of 40 or higher
• You have suffered from morbid obesity for at least the past five years
• You have attempted, under your physician’s care, other methods of weight loss for at least two years
• You have co-morbidities – such as hypertension, diabetes, sleep apnea, degenerative arthritis, and heart disease – that constitute medical necessity for obesity surgery
• You do not have major psychiatric or emotional problems
Any of the following that apply to you should also be mentioned:
• You have significant liver, kidney, or gastrointestinal disease
• You have a history of alcohol or substance abuse
• A thyroid test has been ordered and results will be sent to your surgeon
Even if your pre-authorization for obesity surgery coverage is denied by your insurance company, there is still a chance that you can receive full or partial coverage for the cost of your bariatric surgery through the appeals process. During the appeals process, you may contest each reason your insurance company has given for denying coverage. It is critical that you submit your appeal quickly in order to have the best chances for a successful outcome. In some instances it may be helpful to employ the services of an insurance advocate or lawyer to help you effectively navigate the appeals process. Your insurance company may limit the number of times that you can appeal for weight loss surgery coverage, so make sure that you understand the guidelines set in your "certificate of coverage."
If you have gone through the approval, authorization, and appeals process and are still unable to get insurance to cover the cost of bariatric surgery, you still have options. Many financial lenders offer financing to help make payment for weight loss surgery easier on patients. Financing is also an option for those with benefits that only cover part of the cost of their gastric bypass or LAP-BAND® surgery. Many surgeons understand that weight loss surgery is a high cost procedure that yields beneficial life-changing results, so they are often willing to assist patients by providing information on available financing programs and payment plans.
Do you have questions about weight loss surgery cost, insurance coverage, or financing? If so, the first step is getting in contact with a bariatric surgeon who can evaluate your weight and health, and inform you about the surgical weight loss options available to you. If you are a good candidate for surgery, you and your surgeon will discuss the cost of bariatric surgery procedures, such as LAP-BAND® and gastric bypass surgery.