Weight Loss Surgery with Insurance – Overview
Obesity is one of the most prevalent health disorders affecting adults and children alike in the US. Various extensive studies have been conducted by the Centers for Disease Control and Prevention (CDC) in the past several decades. For instance, the US obesity prevalence rate was around 42.4% in 2017-18 with severe obesity increasing from 4.7% to nearly double at 9.2% in 2017-18. Persons suffering from obesity are known to develop one or more serious health disorders, such as stroke, heart disease, type 2 diabetes and some forms of cancer. Obesity has become the leading cause of premature, preventable deaths in the country.
Thanks to advances in gastric science, it is possible to treat obesity effectively. However, the cost of obesity surgery in the US is still considerably expensive. Hence, many people suffering from obesity wonder whether their insurance will cover weight loss surgery.
Let’s find out.
What is the Average Cost of Weight Loss Surgery in the US?
The average cost of gastric bypass surgery in the US is around US$ 23,000. The average cost of sleeve gastrectomy surgery in the US is around US$ 14,900 while a lap band gastrectomy will cost you anywhere around US$ 14,500. So, before you jump to book yourself an appointment with a gastroenterology specialist, it’s advisable to enquire whether your insurance policy offers cover for weight loss surgery or not.
According to reports, the majority of patients who undergo weight loss surgery in the US belong to the middle or upper-class strata. However, most patients suffering from obesity and related issues can’t afford the extremely expensive cost of a weight loss surgical treatment. This is where insurance companies come in handy.
Will My Insurance Provider Cover the Cost of Weight Loss Surgery?
Whether your insurance company covers the cost of weight loss surgery depends on various factors.
As a rule, insurance companies do not cover the cost of “experimental” weight loss procedures, such as duodenal switches, gastric sleeves, lap gastric bands and mini-gastric bypass surgeries. However, it is more likely that your insurance provider will include cover for the cost of laparoscopic gastric bypass, gastric sleeve and lap gastric band surgeries. Still, this does not necessarily mean that your particular insurance provider will cover the cost of weight loss surgery.
The insurance company has the discretion to provide or reject handling the cost of weight loss surgery. You will need to read the terms and conditions of your health insurance policy to know whether the cost of weight loss surgery, and the type of weight loss surgeries, that are covered under it. Some insurance policies explicitly exclude weight loss surgeries from their list of approved treatments. Some insurance providers tend to charge more to include weight loss surgery coverage in your insurance policy. The best way to check if your health insurance policy offers coverage for the cost of weight loss surgery, we advise you to contact your carrier directly. You can find their number usually on the back of your insurance card.
What Kind of Insurance Policies Cover Cost of Weight Loss Surgery?
The fact whether your insurance provider will offer to cover the cost of weight loss surgeries depends on several factors, mainly on how you bought your health insurance. For instance,
- Family, Individual and Small Group Plans (with less than 50 employees), such as Obamacare, dictates the majority of states to provide cover for weight loss surgery.
- Large Group Plans (with more than 50 employees) dictate that it is completely up to the insurance provider whether they choose to provide cover for weight loss surgery costs. To clear this, you can enquire with your workplace’s HR department, or contact the insurance provider directly.
- Medicaid and Medicare are federal insurance initiatives and offer to cover the cost of weight loss surgeries. However, you will need to enquire with your choice of bariatric surgeon whether they accept payment for weight loss surgery through Medicare or Medicaid.
The majority of surgeons will help check your insurance benefits without additional cost. These checks can be done quickly through the surgeon’s office. Hence, it is highly advisable to contact your local surgeon and request them to check the benefits of your insurance policy.
On average, the out-of-pocket cost of undergoing weight loss surgery with insurance cover comes down to around:
- Highly Deductible Plan – US$ 1,901
- HMO – US$ 1,475
- POS – US$ 2,270
- PPO – US$ 2,542
In case your health insurance policy does not cover the cost of weight loss surgery and the cost of the surgery is not affordable, then you can also choose to apply for a medical loan. There are numerous companies that tie up with weight loss programs to offer loans to patients who want to undergo weight loss surgeries to improve their overall health by preventing severe disorders and complications from being obese.
To know if your insurance policy offer covers weight loss surgery, we advise you to contact the insurance carrier directly. You can also contact the HR department if you have insurance provided by your employer. In case your health insurance policy does not include cover for weight loss surgery, you can even apply for a medical loan or grant.