Most major insurance companies and Medicare pay for surgical weight-loss procedures.
Financing often gets in the way of good health. With some diligence, however, if you are considered extremely obese and qualify for surgical weight-loss procedures, you can get your surgery with little-to-no out-of-pocket expenses through insurance, including Medicare, or through credit financing options if you don't have insurance. Moreover, you can negotiate with the surgery center so that you can pay for your procedure through installments.
Costs of Surgical Weight Loss Procedures
Surgical weight-loss procedures cost from $20,000 to $25,000 on average, as of 2010. Open surgery costs more than laparoscopic procedures, and costs also vary by the surgeon and the hospital or facility where you have the surgery. The surgery is not out of financial reach if you have a low income. If you qualify for Medicare or Medicaid, the U.S. Department of Health and Human Services has made special provisions for you to get the surgery, as long as it is medically appropriate.
Types of Surgery Available
Several types of operations are commonly offered in the United States, including adjustable gastric band, Roux-en-Y gastric bypass, biliopancreatic diversion with a duodenal switch and vertical sleeve gastrectomy. The invasiveness and complexity of the procedures vary greatly. In general, surgical weight loss involves some kind of modification of the digestive track to reduce the amount of food you can take in and absorb. Some insurance companies will cover only specific procedures.
Insurance Options
Health insurance is the preferred finance option for bariatric surgery. You can avoid expensive hospital fees and having to navigate a complex system of accounting offices if you go through your insurance. Major insurance companies, including BlueCross BlueShield, Medicare and Medicaid, Aetna, United HealthCare and Cigna, cover certain surgical weight-loss procedures provided you meet certain conditions.
The surgery must be performed by an approved physician in an established bariatric program. Your body mass index, a figure calculating your weight in relation to height, must be 35 or greater. Some require that you have some co-existing medical problems, such as diabetic complications, high blood pressure or sleep apnea, that necessitate the surgery. Others require you to have tried a medically supervised weight-loss lifestyle intervention before approving the surgery.
Sometimes an insurance company may turn down your request to cover the surgery. The company may say the procedure is not medically necessary or is experimental. You should exhaust your insurance company's appeal process, and if you can't resolve it, turn to your state's external review board to see if you can overturn the denial.
Credit and Financing Options
If you do not have insurance, find out if you qualify for Medicaid or Medicare, which provides health insurance to people who live on low incomes. If you don't qualify for these programs, you can negotiate a self-pay arrangement with the facility. Some programs offer low-cost financing to those with good credit.
You also may seek out a loan from your bank. Consider taking out a home equity loan or line of credit if you are a homeowner, as doing so can often get you a reasonable interest rate. Also, ask the finance director of the weight-loss program if it accepts credit card payments.
If all else fails, ask your close friends and family to help you cover the costs of the surgery.
Clinical Trials and University Medical Centers
Numerous clinical trials explore the benefits of bariatric surgeries. Some of them may provide you with the surgery or facilitate your getting it. You must meet numerous conditions to be considered for enrollment in a clinical trial, however, and involvement will likely be a long-term commitment.
Also consult with your local university medical center. Many of them have surgical weight loss programs that can offer you advice about financing the surgery or refer you to trials and other research centers that will help with the costs of surgery.
