How to Pay for Bariatric Surgery Without Insurance
Bariatric surgery is an expensive surgery. Insurance coverage for weight loss surgery is limited, and the cost of the surgery often makes it an unaffordable procedure. If you are left wondering how to pay for bariatric surgery without insurance, there are various options for you. The average cost for surgery is about $20,000 and can range from $15,000 to $50,000, depending on your location.
According to Obesity Coverage, a bariatric surgery information site, the average cost of lap band surgery is $14,500, the sleeve gastrectomy is roughly $17,500, and the gastric bypass is, on average, $23,000. The cost may surprise and alarm many, but the money saved post-surgery on the absence of significant health issues and extending your life span far outweigh the initial price tag of weight loss surgery.
The reasons for the considerable surgery cost are due to the need for experienced surgeons and the necessary tools for preparing for surgery. This is a surgery that can be performed throughout the world, but many elects to have adequate health care and need insurance to cover the many costs of bariatric surgery. The many health costs include bariatrician, dieticians, and psychology visits over as long as nine months, and these visits are mandatory to schedule bariatric surgery.
Insurance companies are resistant to paying for this surgery because of their large one time expense. Although the initial surgery expenses appear high, the long-term health benefits significantly reduce lifelong health costs for the patient. The comorbidities affecting patients with obesity can cost roughly $10,000 a year due to large amounts of health and food-related expenses. Weight loss patients who have undergone bariatric surgery have their health costs dropped significantly to about $2,000.
Although the price tag may appear expensive, choosing to enter into debt for bariatric surgery is a well-made decision based off of what it can do for your overall health and happiness, which decreases your total health costs over time.
To Get Insurance to Cover Your Weight Loss Surgery:
- Proof that surgery or medical intervention is medically necessary. Your surgeon can help provide your medical history and documentation of your weight-related health problems.
- Participation in a physician-supervised diet program. This may include a completed six-month weight loss program for approval. Medicare does not require a six-month program, but you may be encouraged to participate anyway.
- Psychological evaluation: Make sure you understand weight loss surgery and the impact it will have on your lifestyle. This evaluation checks on any untreated binge eating or any other psychological issues.
- Nutritional evaluation: You will work one-on-one with a nutritionist to outline specific dietary changes and habits that need to be changed.
What Happens Next?
After you have completed these steps, your surgeon sends a preauthorization request letter to your insurance company. This letter outlines your medical history and health problems related to your weight and provides documentation you have completed for approval.
Your insurance company then reviews your case.
What Happens When You are Denied Coverage?
Then you can file an appeal if there is only a small percentage of coverage. This letter should include:
- An explanation of why you feel the procedure should be covered.
- A request for a full explanation of why coverage is being denied or paid at a reduced level.
- A request for a copy of the specific statement taken from the policy or benefits booklet that explains why your coverage is limited or denied.
- A copy of the denial notification.
- A copy of your doctor’s preauthorization request letter.
How to Pay for Bariatric Surgery Without Insurance When You're Not Covered
- Medical Loan: A guarantee with collateral, such as a home or car. Depending on the value of your collateral, you can borrow up to the full cost of bariatric surgery. This can help you qualify for low-interest rates, more so than other loans. There is a usual repayment period of ten years.
- Hospital Payment Plan: This pay plan is useful if you can qualify for it. Some hospitals allow you to spread out the cost of surgery for several months or even years with low-interest rates. You can speak with your hospital’s billing department to find out their payment plans.
- 401(k) Loan: A retirement plan loan can help you pay for bariatric surgery. This is borrowing money from yourself. You can take out the desired amount and then make monthly payments. This payment method is not recommended due to its higher risks.
- CareCredit: This is a credit card used only for qualified medical expenses and can be useful in paying for your bariatric surgery.
- Health Savings Account: Based off of the insurance you already have, you may have a high deductible that can qualify you for a health savings account. This account is similar to a personal savings account, but the money is only used for health-related needs. This works perfectly with bariatric surgery. This is seen as more effective than using a personal savings account.
- Personal Loan: When you have decent credit, taking out a low-interest loan can be a smart option. These loans do not require collateral and can help pay for weight loss surgery.
As of 2016, nearly half of all state-mandated coverage included bariatric surgery. Most insurance companies realize that people who are overweight and obese are more likely to have severe health conditions such as type 2 diabetes, high blood pressure, heart disease, high cholesterol, and sleep apnea.
If you do not have health insurance, have insurance through a large employer, or live in a state that does not include bariatric surgery, you’ll likely have to pay the entire bill yourself. Some weight loss centers can help you get a loan that you can repay over several years.
What to Do if You Have No Insurance Coverage?
Cash is a flexible option when you do not have insurance as an option for bariatric surgery. When you pay with cash, you can choose exactly which surgeon you want to perform your surgery. There is no jumping through insurance hurdles and finding in-network carriers.
- Choose the surgeon rather than an in-network provider.
- You can have surgery at the facility you want rather than insurance approved facility.
- No risk of being turned down at the last minute because of a coverage issue. Many receive calls from their insurance company a few days before surgery, informing that they can’t cover the procedure for one reason or another.
Insurance Might Not Cover Complications
If you paying cash, your insurance company might not pay to have a complication fixed. Redo procedures typically cost upwards of $10,000. A leak can cost even more. Talking to your surgeon about possible surgery complications is imperative for your peace of mind.
Is Cash a Better Option?
Cash patients have more options regarding the type of procedures they can choose from. Be prepared and always ask what is included when you pay cash for your surgery.
My Insurance Experience
I chose bariatric surgery due to many health issues that affected my short and long term health.
I was diagnosed with type II diabetes, PCOS (polycystic ovarian syndrome), high cholesterol, high blood pressure, and depression. Bariatric surgery was a choice to treat all of my short and long term conditions.
I was able to get full medical coverage through my insurance with my comorbidities.
Chronic diseases that go along with morbid obesity severely shorten one’s lifespan, and having the ability to change my life course is a blessing.
Many are not as fortunate as I was in terms of insurance coverage. Many bariatric patients are not able to receive full or partial coverage for their weight loss surgery and have to cover all of their expenses, which can limit where and by whom their bariatric surgery is done and performed.
Also, when surgery is not covered by insurance, some patients may choose to go to another country for cheaper surgery, which increases their risk of infection and possibly life-threatening side effects after surgery. The main destination for bariatric surgery outside of the United States is Mexico.
Insurance plays a pivotal role in how weight loss surgery is covered and used. Insurance is the reason many people, including myself, can take hold of their health and be able to live better.
I would not be the healthy person I am today if I did not have an adequate insurance plan.