Tummy Sleeve Cost and Insurance Guide - Bariatric Journal (2023)

Costs stomach surgery insurance guide

Understanding the cost of weight loss surgery is an important step in preparing to decide if a gastric sleeve is right for you. The total cost of gastric bypass surgery depends on where the surgery is performed, whether you have insurance, whether you have bariatric coverage, and which surgeon you choose.

an abdominal operationIt is a bariatric procedure in which part of the stomach is removed to promote weight loss in patients. The patient experiences rapid weight loss and feels less hungry after the system. This is because the stomach is smaller and the part of the stomach that produces the hunger hormone ghrelin is removed during the operation. The gastric sleeve is also safer than other weight loss treatments, with a lower risk of infections and other serious complications after surgery.

Average cost of stomach surgery

The price of gastric surgery is between the cost of gastric banding and gastric bypass surgery for weight loss. According to our internal research, the average cost of gastric bypass surgery in the United States in 2017 is $14,800 to $15,000, well over $2,000 less than in subsequent years.

This is the amount a patient would pay without any insurance coverage/subsidy. The cost of surgery for an insured patient depends on your coverage and your specific insurance company. To learn more about the details, the patient should contact their insurance company directly for a statement of charges.

Costs for a gastric sleeve in different countries and states

The cost of stomach surgery varies from country to country. Just because the cost of surgery is lower somewhere does not mean the bariatric surgeon is any less qualified. The price is determined by the hospital or institution where the operation is performed, or by the surgeon himself and his fee. They may choose a lower price to encourage more people to choose the surgery and make it more accessible to those who may not have insurance coverage.

The average cost of gastric sleeve surgery in Canada is CAD 19,625 (approximately US$14,800), AUD 4,200 in Australia (US$3,139), and Euro 11,100 in the UK (US$11,928).[2] Traveling to Mexico can cost, on average, about a third of the cost of surgery in the United States and Canada, ranging from $5,000 to $8,000.[3]

state division

Bariatric Surgery Source reports that gastric sleeve costs are lowest in Texas, Nevada, Arkansas and Oklahoma across all 50 states.

The cost of gastric bypass surgery varies from state to state. In New York City (New York), the average price is $19,000, much higher than the national average. In Los Angeles, California, the median price is $16,000, as is Chicago, Illinois. In Wichita Kansas, however, the average cost is only $12,000 and $11,000 in Atlanta, Georgia. The highest averages appear to be in Boston, Massachusetts at $25,000 and Phoenix, Arizona at $23,000.

Costs for location of surgeon/centre

Price information per December 2017:

Gastric surgery costs

In the end, stomach surgery is a matter of work for too many doctors to risk. Here we will detail the costs associated with this weight loss surgery.

Preoperative/before surgery

The Bariatric Surgery Source reports a variety of pre- and pre-op costs. This includes (and is not limited to):
Consultations with a nutritionist/nutritionist (to determine if the patient is ready for the change and has previously tried to lose weight and failed)

• Psychologist/psychiatrist (spiritual permission for surgery)
• Cardiologist (heart health research)
• Laboratory/blood tests, x-ray costs, echocardiogram (ECG or EKG)
• sleep study
• Physician-supervised weight loss program (required by most insurance companies)
• Fees for surgical consultation[5]

during the operation

Cedar-Sinai Hospital Marina Del Ray Hospital includes these costs as standard operating costs associated with gastric bypass surgery. They contain:

• Surgeon costs for weight loss
• hospital expenses
• anesthesia costs
• operating room expenses
• Surgical Assistant Fees[6]

Other non-standard expenses that may occur during surgery include radiologist and pathologist fees to review biopsies if necessary.

Postoperative/after surgery

Post-surgery or post-surgery costs may vary from patient to patient. However, some of the more common costs include vitamins, follow-up doctor visits, visits associated with complications that may occur, gym memberships, new clothes, and the cost of plastic surgery to remove sagging skin (if needed or desired).

Ultimately, it is therefore important to always take the time to research the costs associated with gastric or other surgery. Ask questions that will make your decision easier for both your chosen bariatric surgeon and your insurance company, if applicable. Before undergoing gastric bypass surgery, make sure you fully understand all of the financial obligations associated with the procedure.

Which insurance companies cover stomach surgery?

Here you will find a list of some insurance companies that reimburse stomach surgery at the time of publication of this guide.

• Etna
• Hino BCBS
• BCBS Alabama, Arkansas, Fed og Florida, Kansas City, Texas, Illinois
• BCBS ved HMO da Louisiana
• BCBS Massachusetts
• Blue Cross Michigan Blue Shield
• California Blue Cross
• Minnesota Blue Cross
• Nebraska Blue Cross
• Blue Cross New York Excellus
• North Carolina Blue Cross
• blue cross south carolina
• Blue Cross Tennessee, including state officials and St. Thomas and Baptist officials
• CHAMPVA
• Cigna, Cigna-HealthSpring PPO, ansatte i Cigna, Tennessee
• Coventry's health
• define health
• first health
• Health in the Great West
• Health Spring PPO and Medicare Plus
• Nova Jersey Blue Cross Skyline
• Employees of Humana and Humana HCA
• permanent emperor
• Medicare/Medicaid
• TennCare America
• Tricare North, South and West
• totter
• Unicare
• United Health

Ultimately, each patient's health is different, so each insurer may feel that surgery may or may not be beneficial for each patient. Never assume anything about insurance coverage. Make sure to always get everything down on paper. Contact your insurance company if you have questions about coverage and requirements in connection with the approval of gastric bypass surgery. Although your weight loss surgeon is a good source of information, it is your responsibility to obtain all the details of your coverage.

What are the general requirements for insurance?

United Healthcare (as well as other insurance companies) has a number of necessary requirements in connection with the approval of weight loss surgery, including the gastric sleeve. These requirements include:

• Required body mass index (BMI) confirmed by a doctor
• Typically, BMI should be greater than 40 or greater than 35 with one or more of the following comorbidities, including heart disease, obstructive sleep apnea, hypertension, type II diabetes, or other health problems associated with obesity.
• Must complete a specific period of time with a medically supervised diet program
• Must have a consultation with a bariatric surgeon who believes the patient is suitable for surgery
• You must obtain a medical certificate from your doctor
• Must be licensed for mental health care
• Must schedule a nutritional assessment with an accredited nutritionist[8]

Once these things are done and sent to the insurance company, they will review your detailed medical history and documentation to determine your eligibility for the surgery. It is important to note that each insurance company has specific requirements and requirements for pre-op testing. Make sure you understand these things well before applying for insurance coverage for your gastric bypass surgery.

The review process takes just under a month. The insurance company will send you an approval or denial letter. If approved, your bariatric surgeon will contact you to schedule your gastric bypass surgery. If you are refused, you can choose to appeal the refusal. Much of the work will be done by your surgeon's office, who will be able to confirm that you need surgery.

Does Medicare, Medicaid Cover Gastric Sleeve?

Medicare reports that it covers some bariatric surgical procedures. The costs may change if you are an inpatient or outpatient. Patients can log into their Medicare.gov profile to read a Medicare Summary Notice and see if they've met their deductible. The Part A co-payment applies if someone is admitted to hospital, while Part B applies to doctor visits and outpatient treatment. Individuals will have to pay their deductibles before Medicare starts paying for any health care, not just the stomach sleeve.[9]

As for Medicaid, obesity-related services that help prevent and control unhealthy weight are covered. Patients must meet criteria for the state they live in. Although bariatric surgery is not covered in the coverage guidelines, each patient is treated on a case-by-case basis. Full coverage is available.[10]

Costs for a gastric sleeve without insurance options

Just because you don't have insurance coverage for your weight loss surgery doesn't mean you can't find affordable ways to finance the surgery yourself. Here are some of our suggestions for uninsured surgery.
Consider a medical loan. Many bariatric surgeons work with companies that offer patients loans for surgery for which they do not have insurance coverage.

Apply for Medicaid. Some people qualify and don't even realize it. Check to see if your specific condition covers weight loss surgery before switching (if applicable).

Each state has laws that require an insurance company to cover weight loss if the patient meets NIH health criteria. Check if your country is one of them.

Some surgeons may also reduce the cost if you pay yourself without insurance. Also ask if they work with different hospitals, as hospital costs may differ. Some surgeons even factor all pre-surgical costs into their fees, so paying yourself can save you money here too.

Funding options for abdominal sleeves

Funding can be used to cover the full cost of the surgery or cover the part not covered by insurance. Some options include:

• Payment plan through the surgeon
• unsecured medical loans
• secured medical loans
• Permanent life insurance loans
• Loans for pension schemes

Abdominal surgery abroad

A new trend has emerged: People are choosing to have stomach surgeries on board, such as in Mexico, South America and Europe. This process of traveling to receive medical treatment, usually at a lower cost, is called medical tourism. Proponents of this phenomenon claim that certified weight loss surgeons offer the same procedure at a fraction of the cost as in the United States and Canada.

Many claim that the average cost of surgery is between $5,000 and $8,000.[11] They also work with financing companies for individuals who want to work out a payment plan. In Mexico, patients between the ages of 16 and 65 can opt for weight loss surgery. The requirements are somewhat similar, but according to the center, people with a BMI of at least 30 can have gastric bypass surgery (as opposed to the US with a BMI of 35-40).

How to choose a good surgeon abroad: Choose an accredited surgeon. This surgeon will work with your doctor at home to ensure you have the best post-operative experience. The operating costs are included in a package that sometimes even includes the necessary hotel before returning to your home country. Air tickets are not included in the price. Although the trend is increasing

Tax deduction for stomach surgery

Fortunately, weight loss surgery in the United States is tax deductible if the cost exceeds 10% of your adjusted gross income. [12] This appears in Appendix A of a patient's 1040 form. Keep all medical bills and payment statements as sufficient proof of expenses incurred in that tax year.

Conclusion

In general, the cost of gastric bypass surgery varies from place to place. Taking the time to research all associated costs will help you make an informed decision. Whether you have insurance coverage or your insurance company pays a certain amount will determine your overall plan for financing your weight loss surgery. Internal weight loss surgery is an excellent option for people who want to save money on surgery or don't have insurance.

with a variationgastric surgery optionsmany patients who want to control their obesity with weight loss surgery can successfully do so.