When Cecelia, 37, heard the surgeon recommend gastric bypass surgery, she felt both relieved and surprised. At 5’4” and 278 pounds, she had failed at one attempt after another to lose weight ever since second grade. Only when she arrived home and started to look at the paperwork associated with the procedure did the anxiety strike. How on earth would she pay her portion of the cost for the surgery?
According to the Mayo Clinic, gastric bypass is the weight loss surgery most often performed in this country. To qualify, patients usually have to have a body mass index (BMI) or 40 or more. For those whose BMI falls between 35 to 39.9, doctors recommend the surgery only if they have other serious problems related to weight. Among them are high blood pressure and diabetes.
Each patient has a different experience and outcome, sometimes related to the type of gastric bypass surgery performed. The most common procedures are the Roux-en-Y and the biliopancreatic diversion with duodenal switch. Other types of surgery to create weight loss include Lap-Band adjustable gastric banding (LAGB), vertical banded gastroplasty and sleeve gastrectomy.
In 2004, USA Today reported that the average cost for a gastric bypass procedure was $26,000. Health insurance companies for the most part pay for the procedure only if the patient meets their respective guidelines for medical necessity. Medicare covers bariatric surgery if the patient is obese and has other life-threatening conditions like heart disease. What Medicaid will pay varies per state.
In addition to the hospital’s charges, patients typically receive bills for the surgeon’s services, hospital visits from any other physicians, anesthesia and diet and nutrition counseling. The cost also varies according to the type of procedure performed. Less-obvious costs include any unpaid time off work and additional child or pet care cost during recovery.
The staff of most weight-loss surgeons normally takes the initiative of contacting the patient’s health insurance, Medicare or Medicaid to get an initial approval for the procedure, an estimate of what will be paid and the amount for which the patient might be responsible. The Consumer Guide to Bariatric Surgery cites the average cost of gastric bypass surgery as between $17,000 and $35,000. It advises that patients might face additional post-operative costs such as a facelift, breast lift, abdominoplasty or liposuction. These procedures aren’t usually scheduled until a year or two after the gastric bypass procedure has been performed.
The cost of the surgery also varies by region of the country. It’s usually higher in urban areas like New York and other East Coast cities due to higher overhead in those areas. There is also a greater demand for surgeons in these higher-cost areas than in other regions. The cost of gastric bypass surgery is steepest in the northeastern United States, followed by the West Coast, the central states and the South.
Health insurance coverage varies widely when it comes to weight-loss surgery. Most surgeons are willing to help patients file an appeal by providing detailed documentation to support the necessity for surgery if the initial request for approval was denied.