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The Cost of Gastric Sleeve Surgery Without Insurance: How to Navigate Successfully and Safely

The Cost of Gastric Sleeve Surgery Without Insurance: How to Navigate Successfully and Safely

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      Insurance plays a central role in any weight loss surgery. There are many appointments you have to keep with your bariatrician, dietician, and psychologist. These are costly appointments leading up to surgery, and many cannot afford the pre, post, and surgery costs.

      Weight loss surgery is expensive. Depending on the surgery selected, typical costs can run up to tens of thousands of dollars. Gastric sleeve surgery specifically can cost $3,500 to $26,000; this is influenced by a variety of factors ranging from your insurance, to surgeons’ fees, anesthesiologist fee, surgical assistant fee, device fee and the location of your surgery.

      About 25% of people seeking weight loss surgery are denied coverage three times before their health insurance approves the procedure. According to the Affordable Care Act, 23 states are now required to cover weight loss surgery.

      Most insurance companies will cover gastric sleeve surgery costs when surgery is proved to be medically necessary. This proof is a thorough documentation of your weight-related health problems. These problems are when you have a Body Mass Index (BMI) of more than 30 and less than 55 and have severe health conditions such as type 2 diabetes, high blood pressure, heart disease, high cholesterol, and sleep apnea.

      Insurance Requirements

      Some insurance companies require participation in a weight loss program to demonstrate your commitment to the necessary lifestyle changes you will need to make after weight loss surgery. These changes include completing a six-month weight loss program before approval is granted for surgery. The weight loss program includes monthly visits to your doctor or bariatric office for six months.

      This process also includes a psychological evaluation where you show you understand the impact of weight loss surgery and its effect on your lifestyle. Common conditions checked are whether you have an untreated eating disorder such as binge eating.

      You are also evaluated for your quality of nutrition. You will work with a nutritionist to outline specific dietary changes and habits that need to be changed. If you do not have health insurance through the state, large employer, or do not live in a state that covers weight loss surgery, then you will likely have to pay the entire bill yourself. Medicare does not require a six-month weight-loss attendance program.

      If your insurance rejects your request for bariatric surgery, you can file an appeal. If weight loss surgery is still rejected, there are other financing options.

      Woman sitting down holding several one hundred dollar bills.
      Monetary Funds are essential in achieving weight loss surgery.

      Financing options when insurance Fails to Cover Surgery

      1. Secure Medical Loan

      This loan guarantees you with surgery coverage through the use of collateral, such as your home or car. Depending on the value of your car or home, you can borrow up to the full cost of your bariatric surgery.

      Because you have to secure your loan with collateral, you can qualify for lower interest rates than you would with other types of loans. There is usually a ten-year repayment plan for this type of loan.

      Most banks and credit unions offer secured medical loans. Before applying for a loan, make sure you can afford it. If you fall behind, the bank can seize your collateral.

      2. Hospital Payment Plan

      Some hospitals allow you to spread out the cost of gastric sleeve surgery without insurance over several months or years at a low-interest rate. You can contact your hospital’s billing department to find out their payment plans.

      Picture of the inside of a surgery room.
      Surgery is possible through planning and organization.

      3. 401 (k) Loan

      You can use your retirement fund to pay for the cost of gastric sleeve surgery without insurance. By taking out a 401(k) loan, you are borrowing money from yourself. You make monthly payments on your loan with interest. You can generally borrow up to 50% of your account balance. There may be maintenance fees added to your loan.

      Loan analysts do not recommend this loan due to the loss of your account growth, which can cost you thousands of dollars over time.

      4. CareCredit

      This payment is through a credit card, where you can only use it for qualified medical expenses. If you can afford the repayment in the allotted promotional period or less, you will pay no interest as long as the balance is paid in full.

      If you do not pay off the balance in the promotional period, CareCredit will charge you interest.

      5. Health Savings Account

      If you have a high deductible health insurance policy, you will qualify for a health savings account. This account works like a personal savings account, but the funds are only used for health-related expenses.

      This can be more cost-effective than a personal savings account.

      6. Personal Loan

      If you have good credit, you can take out a low-interest personal loan. This loan does not usually require collateral, so you do not have to risk your home or other valuables.

      You can borrow anywhere from $1,000 to $100,000 if you have good credit and can pay it off within seven years. Interest rates as high as 35% are added to your loan if you cannot pay within the given time frame.

      Woman doing yoga on a mountain.
      Your health is the outcome of your daily choices and habits.

      Health Costs without Bariatric Surgery

      Obesity-related costs to your life without health insurance can cost up to $11,000.00 a year. As early as 13 months after bariatric surgery, patients spend as much as $900.00 less a month than an obese individual. By eliminating your obesity-related problems, you are saving hundreds of dollars each month.

      More than one-third of adults in the U.S. have obesity. The extra weight leads to many long-term damaging health conditions. These conditions include and are not limited to heart disease stroke and diabetes. Bariatric surgery is a literal lifesaver in tacking the obesity epidemic.

      There is also the added benefit of an improvement to your mental health due to the severely lessened obesity-related discrimination many bariatric patients experience daily.

      Going into debt for gastric sleeve surgery is an excellent investment to your overall health and happiness. This cost is manageable through the six options listed above.

      Woman walking up steps in tennis shoes.
      Every step move you closer to your health goals.

      My Journey Tackling the Insurance Tangled Web

      My insurance covered my bariatric surgery completely, but the time between my first appointment and my surgery date was nine months. The many restrictions and hoops I had to go through were due to my insurance regulations. These hoops included meeting with a food therapist to determine if I had an eating disorder. These eating disorder appointments took four months, and then a psychologist analyzed my mental state to determine my awareness and wellness before scheduling the gastric sleeve surgery.

      The psychologist then denied me surgery. She deemed me mentally unfit for surgery. I appealed this decision and eventually was allowed to schedule my surgery after a month and a half of appealing the decision.

      Even though my insurance covered my surgery, the many hoops I went through to have surgery scheduled were extensive. This included monthly appointments with my bariatrician, dietician, primary doctor, endocrinologist, and OBGYN. I have never spent so many hours in doctors’ offices. I became quite comfortable with the doctors’ office setting and demeanor.

      Having and not having medical insurance is a blessing and a curse at times. There are many restrictions and requirements placed upon you as a bariatric patient to received approval. In retrospect, I am glad for the hard work and resiliency I needed to become successful and remain successful pre and post-surgery during my weight loss stage and now in the maintaining weight-loss stage of my journey.

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        Kelsey Renae Schulze

        Author

        Kelsey is a post-op bariatric patient who had sleeve surgery in 2018. She is a writer, focusing on a variety of topics given her background in legal studies and criminal justice.

        Gintas Antanavicius, MD, FACS, FASMBS

        Medical Reviewer

        Dr. G is a co-founder of BariBuilder. A US-based expert surgeon with over 10 years of bariatric experience, he regularly publishes research in medical journals like SOARD, Obesity Surgery, etc.