Gastric Bypass Surgery Cost – As Low as 0, But Average Is 3,500 – Bariatric Surgery Source
1. united states: covered if your plan includes bariatric surgery
in the usa In the US, gastric bypass is covered under any plan that includes weight-loss surgery.
how do you know if your insurance includes weight loss surgery?
varies depending on how you get your health insurance:
- individual/family plans & small group plans (less than 50 employees): many states are required by obamacare to cover weight loss surgery.
- large group plans (50+ employees): It is 100% up to the company whether the chosen benefit plan includes bariatric surgery. ask someone in the human resources department or contact your insurance company to see if you’re covered.
- medicare & Medicaid: Both federally sponsored plans cover gastric bypass surgery, but not all surgeons accept Medicare and Medicaid.
- hmo: $1475
- ppo: $2542
- pos: $2270
- high deductible health plan: $1901
- zero dollars paid toward your calendar year deductible for other services
- calculated using special formulas based on average plan designs from the kaiser family foundation’s annual survey of employer health benefits (1)
- cardiology exam
- lab work
- medically supervised diet program
- psychological exam
- sleep study
if your policy covers it: ask for a free insurance review
Most surgical offices will verify your insurance benefits for free. More importantly, they will usually do it quickly as they have staff who are experienced in dealing with insurance companies.
Instead of doing your own research, contact your local surgeon’s office to verify your insurance benefits.
Contact a surgeon for a free insurance verification.
The following are the average out-of-pocket costs for gastric bypass if you have insurance:
see below assumptions:
if your policy doesn’t cover it: look for partial coverage
Insurance will likely pay some of the costs associated with weight-loss surgery, even if you have a plan exclusion for bariatric surgery. Whether some of the costs are covered depends on how your medical team submits claims to the insurance company.
For example, there are many reasons unrelated to weight loss surgery that your doctor might request:
Since the above may or may not be ordered for a reason other than weight loss surgery, the costs may be covered by insurance. If your doctor files one of these claims using a weight loss surgery CPT code (Current Procedural Terminology code), it’s unlikely your insurance will cover it. but if your doctor uses a general cpt code, it’s probably covered.
We assure you that the most outstanding doctors do this. it’s an ethical choice because this type of testing can be beneficial to your health, whether or not you end up with weight-loss surgery.
united states insurance approval process
Getting your insurance company to approve your gastric bypass surgery takes between 1 and 12 months. below are the steps:
- You meet the body mass index (BMI) requirements and that fact is documented by your doctor:
- BMI of 40+ -o-
- bmi greater than 35 with one or more of:
- clinically significant obstructive sleep apnea
- coronary heart disease
- medically refractory hypertension
- type 2 diabetes mellitus
- Other health problems related to obesity
- everything you received in steps 1 – 6 above
- a history of health problems resulting from obesity
- additional problems caused by your weight and any attempts at treatment
- if yes, your weight loss surgeon’s office will call you to schedule
- if no, you can try to appeal the denial.
- weight loss surgery in canada
- weight loss surgery in australia
The surgical practice you choose can do almost all of this for you. all required experts are likely to be on staff (registered dietitian, psychiatrist, bariatric coordinator, etc.).
For more information on gastric bypass insurance, see our guide for patients with bariatric surgery insurance.
If you are interested in information about insurance coverage for weight loss surgery outside of the US. uu. visit our country specific pages below: