The Price of Gastric Bypass Surgery

What You Might Pay If Insurance Doesn't Cover the Procedure

Overweight women at nutritionist's office
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The price of gastric bypass surgery is a top concern for those who are candidates for the procedure. Many patients also wonder if insurance will pay for the procedure. Having medical insurance doesn't mean you won't need to pay for all or part of the procedure yourself.

Will Insurance Pay It?

It is important that you review your policy or speak with your insurance company directly to determine if you are covered. Some insurance plans explicitly exclude obesity treatment, weight loss surgery, and related care, which means that they will not cover any related charges you may incur from preparing for, having, or recovering from your gastric bypass procedure.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), gastric bypass surgery costs between $15,000 to $25,000 on average. Whether or not the procedure and related costs are covered by health insurance depends on your insurance company, your state, and your specific policy, among other factors. 

Your chances of having insurance pay for gastric bypass are increased if you have health problems due to obesity and if a board-certified surgeon recommends it.

How to Get Insurance to Pay

If you are covered by an HMO, you will need to see your primary care physician to obtain his approval before seeing a specialist like a bariatric surgeon. Once you have seen the specialist and have been approved as a candidate for weight loss surgery, you will need to begin the pre-authorization process.

The approval process for weight loss surgery can be a bit more complicated than it is for other common medical procedures. It is likely that your insurance company will request both your physician and your surgeon send in something called a "letter of medical necessity" as part of the weight loss surgery pre-authorization process. Basically, your doctors will tell the insurance company how the procedure will improve your health and overall well-being.

At this point, your request for authorization will be approved, denied, or the insurance company will request additional information. Your doctors may need to follow up with phone calls, further documentation, or additional letters as requested by your insurance company.

If you are denied pre-authorization by your insurance company, you can appeal the decision. All insurance plans offer an appeals process and they are legally obligated to disclose to you your right to appeal.

You are typically allowed a 30 to 60-day window from the date you were denied to appeal. The process usually begins with a letter of appeal being sent to the insurance company by you, your surgeon and your primary care provider.

Medicare Coverage

Many patients want to know if Medicare covers the cost of gastric bypass. In fact, the government health program does cover some bariatric surgeries and laparoscopic banding. If you are on Medicare, a portion of the costs of gastric bypass surgery and related care may be covered, but generally only if you are both obese and suffer from an obesity-related disease such as type 2 diabetes or coronary heart disease. For the expenses to be covered, you must have the procedure at a Medicare-approved facility.

Total Price of Surgery

Those whose surgery is pre-approved and covered by insurance should remember to factor in any copays or co-insurance costs that will need to be paid out-of-pocket. It's important to understand the total cost of your bypass before you make your final decision.

Talk to your doctor about follow-up care, and possible post-surgery procedures (like skin tightening to fix loose skin) that you might need. These costs should be clearly specified by your health insurance policy. If not, call your provider and ask specific questions so you know how much money you need to invest.

Total Cost of Gastric Bypass and Aftercare

If you decide to obtain financing for medical costs from a private lender, you will need to factor in all of the expenses you will be faced with when calculating the amount of financing you need. Your physician should able to provide you with details about the anticipated costs.

Typical Expenses

  • Psychologist appointments
  • Nutritionist consultations
  • The surgeon bill
  • Anesthesia expenses
  • Medical tests that will be needed before and after the surgery
  • Medications

Whether you choose private financing or a payment plan with the hospital, you will need to establish exactly what your payments will be, and if they're due bi-weekly or monthly, so you can plan your budget accordingly.

Patients Who Pay Out of Pocket

If you do not have health insurance, or, your insurance does not cover weight loss surgery, you will need to cover your costs yourself. This is referred to as being a self-pay patient. It is also referred to as "paying out of pocket."

Hospitals offer payment plans for some services allowing you to make payments towards some or all of your expenses rather than being charged in one lump sum.

Another option is to pursue private financing from a lender for your medical expenses, but as with any other type of personal loan, you will need to consider the finance charges (interest rate) and fees.

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Article Sources
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  1. National Institute of Diabetes and Digestive and Kidney Diseases. Definition & Facts for Bariatric Surgery. Updated July 2016.

  2. U.S. Centers for Medicare and Medicaid Services. Bariatric surgery coverage. Updated 2020.