Last Updated on April 24, 2022 by Anne-Sophie Reinhardt
Does insurance cover weight loss surgery? And how much does it cost with or without insurance? In short, these questions have been asked many times. So, let’s walk through it with us in this article.
Obesity is a common health condition that affects both children and adults in the United States. The Centers for Disease Control and Prevention have conducted numerous studies over the last several decades.
In the US, for example, obesity was at 42.4% in 2017-2018. The prevalence of severe obesity increased from 4.7% to almost double at 9.2% in 2017-2018. Obese people are more likely to have heart disease, stroke, type 2 diabetes, and other serious health problems. Obesity is now the leading cause for premature and preventable death in the country.
It is now possible to effectively treat obesity thanks to gastric science. But, obesity surgery is still costly in the United States. Many people who are obese wonder how much their weight loss surgery costs with and without insurance.
- 0.1 What is the Average Cost of Weight Loss Surgery in the US?
- 0.2 Will My Insurance Provider Cover the Cost of Weight Loss Surgery?
- 0.3 What Kind of Insurance Policies Cover the Cost of Weight Loss Surgery?
What is the Average Cost of Weight Loss Surgery in the US?
Gastric bypass surgery costs in the US average around US$ 23,000 The average cost for sleeve-gastrectomy in the US is approximately US$ 14,900, while a lap band will run you around US$ 14,500.
Before you rush to book an appointment with a gastroenterologist, make sure to check if your insurance policy covers weight loss surgery.
According to reports, most patients who have weight loss surgery in the US are middle- or upper-class. Patients with obesity or related problems can’t afford to pay for the high-priced weight loss surgery. Insurance companies are here to help.
Will My Insurance Provider Cover the Cost of Weight Loss Surgery?
There are many factors that will determine whether your insurance company will cover the cost of weight-loss surgery because they generally don’t cover “experimental” weight-loss procedures such as gastric sleeves, lap gastric band, duodenal switches, and mini-gastric bypass surgery.
It is more likely, however, that your insurance provider will cover the cost of lap gastric bands, gastric sleeves, and laparoscopic gastric bypass. However, it does not mean that every insurance company will cover weight loss surgery.
The insurance company can either provide weight loss surgery or refuse to cover it. To determine if weight loss surgery is covered by your insurance policy, you will need to review the terms and conditions. Some insurance policies exclude weight loss surgery from their approved treatment list. Weight loss coverage is often included in insurance policies that are more expensive by some insurance companies. It’s best that you contact your insurance company directly to verify that your policy covers weight loss surgery. Their number is usually located on the back of your insurance card.
What Kind of Insurance Policies Cover the Cost of Weight Loss Surgery?
It is dependent on many factors that will determine whether or not your insurance company will cover weight loss surgery costs. Take, for example:
- The majority of states provide coverage for weight loss surgery through either individual, family, or small group plans (with fewer than 50 employees), such Obamacare.
- Large group plans (with over 50 employees) require that the insurance provider decide whether to cover weight loss surgery costs. You can ask your employer’s HR department or contact the insurance company directly to clarify this.
- Medicare and Medicaid are federal insurance programs that cover weight loss surgery costs. You should ask your bariatric surgeon if they will accept payment through Medicare or Medicaid for weight loss surgery.
Most surgeons will check your insurance benefits for you without extra cost. These checks can be performed quickly at the surgeon’s office. It’s best that you contact your local surgeon to verify the benefits of your insurance plan.
The average out-of-pocket expense for weight loss surgery when accompanied by insurance coverage is around:
- High Deductible Plan – US$ 1,901
- HMO – US$ 1,475
- POS – US$ 2,270
- PPO – US$ 2,542
If your insurance policy doesn’t cover weight loss surgery, or the cost is too high, you may be eligible for a loan. Many companies partner with weight loss programs to provide loans to patients who wish to have weight loss surgery. This will help improve overall health and prevent severe complications.
Contact your insurance company directly to find out if your policy covers weight loss surgery. If you have employer-provided insurance, you can contact the HR department. If your insurance policy doesn’t cover weight loss surgery, you may be eligible for a grant or loan.