The cost of bariatric surgery, and what to do if your insurance won’t cover it
The outcome of bariatric surgery is often priceless: dramatic reductions in high blood pressure, type 2 diabetes and sleep apnea along with reduced risk of heart disease and a host of other potentially life-shortening conditions.
But unfortunately the surgery itself has a price tag attached.
So how much are we talking about?
“It depends on the procedure,” says Jennene Wheeler, RN, CBN, coordinator for MultiCare’s bariatric program. “The surgery for a sleeve gastrectomy is about $17,500 and for bypass it’s about $27,000.”
The good news: the price hurdle is often one that patients can overcome on their way to healthier lifestyles because more and more, insurers are willing to cover the surgeries — especially when employers demand coverage.
The two surgeries offered by MultiCare, as referenced by Wheeler, are the sleeve gastrectomy and Roux-en-Y gastric bypass. Both offer dramatic weight loss and the one you choose is based on your specific medical situation.
If you’re paying for it yourself and there’s no particular medical reason (such as serious gastric reflux) to avoid the less-expensive surgery, the cost difference is certainly a factor to consider, Wheeler says. However, if bypass seems to fit your specific needs better, it may be worth it to pay for the more expensive procedure up front, rather than having to pay for a second procedure.
As with most bariatric surgery centers, there is a package price for cash-pay patients with no insurance coverage, Wheeler says, but it’s still more than most of us can easily spend out of pocket. And if you don’t have insurance coverage for the procedure and immediate pre- and post-op care, you likely don’t have coverage for the long-term follow-up care that is required.
Luckily, most major insurance providers have benefits that include coverage for bariatric procedures, Wheeler says. But it’s still up to individual employers to decide which benefits to offer.
Fortunately, employers are increasingly recognizing the benefits of bariatric surgery for employees and providing insurance that covers it, Wheeler says.
“Boeing, Amazon, Costco, Microsoft, all of them have benefits,” Wheeler says. “A good percentage of the unions will cover bariatric surgeries in their insurance coverage.”
If your employer-provided insurance plan doesn’t cover bariatric surgery, you may need to do some lobbying on your behalf, either with your company’s human resources department or your union reps, Wheeler says.
“If you want these benefits added, go to HR, go to your employer and advocate for yourself,” Wheeler says. “Employees don’t know they have that power. But it’s your benefit. You can ask for coverage you want.”
In some cases, employers or insurers will provide bariatric coverage on a case-by-case basis. But that requires patients to ask.
“Most of the people with the stigmatization of being obese don’t want to draw attention to it,” she says. “But they are the ones who really need to speak up.”
The MultiCare Center for Weight Loss & Wellness is working on a formal program to educate local employers and insurance companies about the benefits of bariatric surgery and medical weight loss — as a way to encourage them to cover it, Wheeler says. Many employers don’t realize they can see a reduction in employee sick days and an increase in employee productivity when bariatric treatment is an option.
If you do have insurance coverage, you will likely need to jump through a few hoops to qualify. Some programs require you to use specific bariatric surgery centers. Many require a waiting period. All require you to meet a body mass index (BMI) for a period of time to ensure that the obesity is chronic, as well as a psychological evaluation.
Often, patients will need to try a medically supervised diet for a period of time before surgery is approved, Wheeler says. But that’s good practice for the lifestyle changes you’ll need to make to ensure surgery is successful in the long run.
Despite increasing numbers of insurers providing coverage, Wheeler says the clinic still sees a handful of self-pay patients each month. If you can’t get insurance coverage, there are financing options, such as a company called Med Loan Finance, an independent lender that can provide relatively low-interest rate loans for medical procedures.
“We also have patients who take out a personal loan or a line of credit,” she says.
In the end, the discipline and effort required to pay for bariatric surgery can help prepare you for the discipline and effort required to make the surgery a success.
The MultiCare Center for Weight Loss and Wellness supports you before, during and after the weight loss journey.