Covering the Cost of Weight Loss Surgery
August 25, 2009 by Terry
Filed under Featured, Weight Loss Surgery
Has your doctor suggested you undergo gastric bypass or lap band weight loss surgery? If so, this is a suggestion you should give serious consideration to. When a doctor suggests bariatric weight loss surgery, he or she is usually doing so to protect your health and wellbeing. For those severely or morbidly obese weight loss surgery can be a lifesaving procedure.
For many weight loss surgery is highly desired but they believe it to be financially out of their reach. In the United States, bariatric weight loss surgeries can costs anywhere from $15,000 to $30,000 or more. Most of us do not have that kind of cash and if we do it is probably in our retirement fund or in a fund for the education of our children. Yes we want and need that lap band or surgery but need options to cover the expense. The good news is that there are options available to us.
Insurance: Today many of our health insurance plans will cover the cost of weight loss surgery. Having your insurance paying for it is not as easy as just asking for the surgery. There are rules and restrictions that will determine if the insurance company will cover the costs. For example, if your doctor is only suggesting surgery, you may be denied coverage. On the other hand, if your doctor is stating that it is a lifesaving procedure due to morbid obesity and you have conditions such as diabetes, high blood pressure, high cholesterol your insurance is more likely to cover the costs.
Today many insurance companies are looking not only at the cost of healing they are looking at the savings of prevention. As an example, if you are 25 years old, the cost of diabetes supplies and checkups can easily exceed the onetime cost of weight loss surgery, making it a wise choice for your insurance provider.
Medicare: Medicare covers the cost of bariatric weight loss surgery on a limited basis. The three types of surgeries that Medicare will cover are:
- The Roux-en-Y bypass. This surgery uses surgical staples to create a small pouch in the stomach that is connected to the bowel by a piece of the small intestine, bypassing most of the stomach.
- Open and laparoscopic biliopancreatic diversions. These surgeries involve surgically bypassing a significant amount of small intestine thereby diverting digestive juices from the liver and pancreas to the lower part of the intestine.
- Laparoscopic adjustable gastric banding. Lap band surgery involves the use of an adjustable band to pinch off a small piece of the stomach.
Weight loss surgery is an option for Medicare beneficiaries with a body mass index (BMI) of 35. The procedure must be medically appropriate and the surgery is to correct an illness that has caused or aggravated by the obesity such as heart disease, diabetes, high blood pressure or sleep apnea among others. Many bariatric practices set the limits of qualification for weight loss surgery between the ages of 18 and 60 (65) as bariatric weight loss surgery is controversial outside of this age group. I was one week short of age 67 when Medicare and my Medicare Advantage plan covered my own gastric bypass surgery.
Medicaid: Medicaid is a federal government’s health care plan for certain low-income individuals and families. The Medicaid coverage of weight loss surgery varies on a state-by-state basis. Some state Medicaid programs are extremely progressive and proactive while others are not. A local weight loss clinic or surgeon can tell you if Medicaid coverage is a possibility in your state.
Loans for Weight Loss Surgery: Bariatric surgery financing is available through many lenders. You will need to make monthly payments on the weight loss surgery loan. As a homeowner you may also want to consider refinancing your home to pay for the surgery if your insurance will not cover the cost of the surgery.
When a patient opt to pay for weight loss surgery using cash, check, or debit card, they are considered a cash patient. This is opposed to a patient with medical insurance. Ask your surgery center or surgeon for a cash discount. While the discount may not be as large as you would hope it will help to cover the cost of the financing or lost interest on the savings you are using for the surgery.
Saving For Surgery: If all other options are out you may need to save for the surgery. Even if you are on a budget, it is still possible to save money for surgery. Start by eliminating unnecessary purchases, such as your morning stop at Starbucks. Carry your lunch instead of dining out. Start carrying bottled water that you bottle at home instead of buying sodas. These steps will not only help you to save they will help you to start losing weight and preparing for the surgery. You may be so successful that you find that you no longer need weight loss surgery.
Remember to discuss all options not just with your family practitioner but with a qualified weight loss surgeon or bariatric surgery center. There are many options available for covering weight loss surgery and my bet is that they will help you find one.
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