How to Determine the Full Cost of Gastric Bypass Surgery

The cost of gastric bypass surgery can vary widely, depending on the type of surgery performed and whether or not your insurance will help pay for it.

When there are no complications, the most common form of weight loss surgery, the laparoscopic Roux-en-Y gastric bypass surgery, can cost from $25,000 to $35,000, or more. The less invasive LAP-BAND® system may cost from $17,000 to $25,000.

If your insurance covers these procedures, your out-of-pocket costs will be significantly reduced, and should be limited to your deductible and copays, plus the cost of any incidental procedures that are not covered.

Why the cost of gastric bypass surgery is hard to determine in advance

The costs of any surgery will go up with complications, especially if a new operation is required or if you need to stay in the hospital longer. If something goes wrong during the surgery, or if you experience an infection or gall stones after surgery, you’ll need to pick up the tab for treatment. More insurance companies are now paying the cost of gastric bypass surgery, but they do usually have strict requirements for eligibility, and pre-approval is almost always needed. If an insurance plan does cover these procedures, they will usually limit their coverage to one or a few specific types of surgery, most commonly the Roux-en-Y gastric bypass procedure. These limitations are based on a review of available safety studies, and the internal policies of the insurance company.

Even though many large insurance companies are now offering coverage for weight loss surgery, many employers do not purchase policies that cover the cost of gastric bypass surgery or other weight loss treatment because of the additional cost. If your policy does not cover the cost of gastric bypass surgery, they will deny any claims associated with complications caused by the surgery.

Additional items that add to the cost of gastric bypass surgery

Since your insurance company may require extensive pre-surgical counseling prior to giving you approval for surgery, you should find out in advance if the pre-treatment program they require is covered under your policy. Often, it is not. They may pay only for the cost of gastric bypass surgery itself, and you may be responsible for everything else. It’s always wise to find out in advance. The obesity center will be able to tell you what the pretreatment program will cost, and they’ll be happy to contact the insurance company on your behalf to find out if their claims will be allowed – but you should double-check and call your insurance company yourself, as well.

What if there are complications?

If you insurance doesn’t cover the cost of gastric bypass surgery, they will probably not cover any treatment that is needed if complications arise. This is often overlooked by gastric bypass patients, who budget only for the surgery in a best-case scenario and assume that if they need to go back to the hospital, because of a gallbladder infection for instance, their insurance will pick up the cost. Be sure to call your insurance company’s customer service line before your surgery to find out what your contract will cover.

Insurance companies hire a team of investigators who look carefully at any type of claim that may be related to costs that are not covered by the policy. Some of the common complications of gastric bypass can be quite expensive, as well as being life-threatening.

Complications can include such things as leakage, infections and gall-stones. Be sure to have a frank conversation with the counselor at the surgical center so you will have a good understanding of all potential complications, along with their risks and costs.

Other costs to consider are any long-term follow up sessions that may be needed in order to prevent nutritional imbalances, and counseling that may be required to make sure you don’t regain any weight. Almost all surgeons suggest ongoing nutritional counseling, and the cost for this necessary assistance may not be covered by your insurance.

How to find out if the cost of gastric bypass surgery is covered by your insurance:

Even if your obesity center calls your insurance company for you, you should also call the health insurance company to make sure you understand your coverage and your options. Also, in case of a future disagreement with your insurance company, you should make a note of the day and time of your call and the name of the representative who quotes your benefits. If you make a decision based on this quote and claims are later denied, you may be able to appeal. This may not be allowed if you get your information only through your surgeon’s office.

Check for contract exclusions in your policy

To see if your policy covers the cost of gastric bypass surgery, find the chapter in your benefit booklet that lists contract exclusions. An “exclusion” is a service or diagnosis that the insurance contract will not pay for, regardless of medical necessity.

Some plans exclude any claim with a diagnosis of obesity. This would include all weight loss surgery and counseling, so you’ll have to look elsewhere for financial assistance.

Other plans exclude “weight loss treatment,” but this may only apply to diet pills and self-help programs. If you find this language in your benefit booklet, you’ll need to find out how they define weight loss treatment. Ask your surgeon’s office for the billing code they will use for the surgery you are considering, and then call the insurance company and ask if that code is covered.

If the billing code is not covered, ask them if it’s because all weight loss surgery is excluded, or just the procedure you asked about. You may be able to find another type of surgery that they will allow, with certain restrictions.

If your insurance policy does cover gastric bypass surgery, with specific restrictions or special requirements, find out if these requirements are in writing. In newer policies the specific requirements will be printed in your benefit booklet or on your company’s Internet web site. One common restriction is the requirement that you have all your pretreatment counseling and your surgery at a Center of Excellence. If this is the case, find out which obesity center in your state has earned this designation. Any surgery performed elsewhere will probably not be covered, and your insurance will not pick up the cost of gastric bypass surgery.

If your insurance will not cover any weight loss surgery, ask the obesity center’s finance office if they make financial arrangements. They are often able to help you find a way to pay for the cost of gastric bypass surgery at their clinic.