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Tag Archives: self pay surgery

What if my insurance doesn’t cover weight loss surgery?

Posted on April 09, 2018 by

If your insurance doesn’t cover weight loss surgery, you are not alone.  Unfortunately, according to the American Society for Metabolic and Bariatric Surgery, less than 1 percent of those who meet the criteria for surgery actually have surgery5.   A big reason for this is lack of insurance coverage.

If you find you do not have insurance coverage, there are self-pay options available (some more affordable than others).  The self-pay cost of weight loss surgery procedures varies by the type of procedure and geographical area in which it is offered (urban areas tend to have a higher fee).  Generally speaking, the average cost for a gastric bypass ranges from $18,000 to $25,000, while the adjustable gastric banding surgery costs anywhere from $17,000 to $30,000.  The sleeve gastrectomy procedure is newer and a price range is not as readily available.  A ball Park Range is anywhere from $14,000 to $22,000.  The price range is also influenced by the supportive program aspects that may or may not be included, the number of follow-up visits, and for the laparoscopic adjustable banding, whether or not any adjustments are included.

The self-pay cost of weight loss surgery generally includes the cost of anesthesia, the hospital facility fee and the surgeon’s fee.  There may also be additional costs for diet and fitness plans, behavioral modification therapy and nutritional products before and/or after surgery.  However, some fees include these services.  For example, at the Center for Weight Loss Success, our comprehensive weight loss surgery pricing including the costs for anesthesia, the hospital and the surgeon is as follows:

  • Gastric Sleeve – $13,995.00
  • Laparoscopic Adjustable Gastric Band – $16,995.00
  • Gastric Bypass – $18,995

However, in addition, an exclusive comprehensive 12 month program is included with these fees.  It is called Weight Management University for Weight Loss Surgery™ and includes the following:

WMU4WLS

You may be surprised that all of these products/services are included, but it’s the right thing to do for optimal long term results and has resulted in a high degree of patient satisfaction and improved outcomes.  For those that travel for surgery, some services are offered online instead of on-site.  No matter who you choose as your bariatric surgeon, make sure that there is a comprehensive program available and ongoing support prior, during and after surgery.

Also, most experienced bariatric surgeons/centers have financing options available.  You will want to verify this and explore your options.  How much is adding 5-7 years of quality life worth to you?

CFWLS-Rhonda-09-

 

 

 

Rhonda’s Opinion:  You will find a way to pay for it…I did and I did not make very much money at the time at all.  You are worth it and Dr. Clark’s program is one of the most comprehensive and affordable programs available anywhere. 

 

Self-Pay Weight Loss Surgery is common – we offer the most comprehensive and affordable options on the East Coast!  Learn more at: Self-Pay Surgery

Will My Insurance Cover Weight Loss Surgery?

Posted on April 02, 2018 by

Insurance coverage for weight loss surgery varies by state and by the insurance provider.  While some insurers may cover the entire bill, many public or private insurance companies will pay a percentage (usually around 80%) of what is considered “customary and usual” for the surgery as determined by the insurance company.  The first step if you are considering weight loss surgery is to contact your insurance provider (use the provider number on your insurance card) and ask “Is weight loss surgery a covered benefit under my policy?”  Many policies require that the employer providing the policy purchase a “Ryder” for weight loss surgery.  Thus, you might also want to ask “Do I have the Ryder for weight loss surgery on my policy?”  The employer must purchase this Ryder for everyone that is covered under the plan, not just a select few.  There are a number of factors that play into this decision for employers.  However, generally speaking, employers who understand the value of weight loss and the employee benefits (improved/resolved co-morbidities, lower health care and medication costs, less time missed from work and increased productivity to name a few) are more likely to purchase the weight loss surgery Ryder.

"My insurance didn't cover Weight Loss Surgery, but I didn't let that stop me!" Allen Fabijan,  'Some Guy Named Allen' from 106.1

“My insurance didn’t cover Weight Loss Surgery, but I didn’t let that stop me!”
Allen Fabijan, ‘Some Guy Named Allen’ from 106.1

If your initial attempt to authorize coverage is denied, you can appeal, and you should initiate your appeal immediately.   Your experienced bariatric surgeon/center will assist you with this process.  It makes good fiscal sense for your insurer to foot the bill for your weight loss surgery.   According to the Obesity Action Coalition, the upfront costs of weight loss surgery are paid off in three and a half years, due to hospitalization cost savings.  What’s more, the cost of drugs for people with diabetes and high blood pressure plummet following weight loss surgery.  Many are able to stop taking such medications altogether as their blood sugar and blood pressure return to normal levels after weight loss6.

Medicare, the U.S. government health plan as know today for people 65 years of age or older states it will pay for three types of weight loss surgery for patients who are treated in “high-volume” centers that achieve low mortality rates.  The three types of surgeries as we know it today include:

  • The Roux-en-Y bypass
  • Open and laparoscopic biliopancreatic diversions
  • Laparoscopic adjustable gastric banding

An experienced bariatric surgeon/center can guide you through the Medicare requirements that need to be documented prior to scheduling surgery.  Medicare does not pre-authorize weight loss surgery so you will need to make sure all requirements are met prior to surgery and submitted properly with your claim.  Some private insurers require a letter of medical necessity from a doctor before they will agree to pay for weight loss surgery.  However, Medicare does not require pre-certification and does not pre-authorize weight loss surgery.  As a result, many surgeons may ask Medicare patients to sign a contract stating that they will pay for any costs that Medicare does not cover after processing the claim.  You can find out your specific requirements regarding diet history by contacting your local Medicare provider. However, at the time of this publication, weight loss surgery is an option for Medicare beneficiaries if they have a body mass index (BMI) of 35, with at least one health problem related to obesity such as heart disease or diabetes.  As you are aware, governmental insurance is currently under debate and potential revision.  Thus, you will want to work closely with your experienced bariatric surgeon/center.

6Obesity Action Coalition website. Fact Sheet: Why it makes sense to provide treatment for obesity through bariatric surgery.

Rhonda’s Opinion:  It wasn’t covered by my insurance – that’s ok – just do it and move into the future.  As I said earlier, you should qualify yourself instead of letting a stranger at an insurance company make your health decisions for you.

Dr. Clark and the Center for Weight Loss Success offer the lowest cost options on the East Coast.  Learn more at: Self Pay Surgery