20 August 2008

"What is the cost of gastric bypass surgery?" While this is a wholly understandable question, unfortunately it is not a simple question to answer.

Gastric bypass surgery is a full surgical procedure requiring the services of a surgical team including a qualified bariatric surgeon, an anesthetist, a psychologist, nutritionist, medical tests, hospital care before and after surgery,at least 2 to 3 days followed by a 2 to 6 week recovery period and medications.

Whether you choose private financing, or a payment plan with the hospital, you will need to establish exactly what your payments will be, and if they're due bi-weekly or monthly, so you can plan your budget accordingly.

Also, like many other forms of surgery, gastric bypass surgery is not without its risks and, while many patients will sail through the procedure, a significant number will develop complications either in hospital or during the recovery period which can push up the overall cost of the procedure considerably.

Against this background it can be seen that the cost is going to be significant and is going to vary widely, but just how significant is it and what sort of variation can be expected?

A minor procedure, such as gastric banding, without complications can be expected to cost around $17,000. This figure will increase to perhaps as much as $35,000 for full gastric bypass surgery. Should complications arise it is extremely difficult to say just what the additional cost would be but it would not be unreasonable to think in terms of a figure of $50,000; further surgery and hospitalization for perhaps several days.

Although gastric bypass surgery is an expensive procedure, the good news is that, in many cases, a substantial part (if not all) of this cost can be met by insurance. This will of course depend upon the type of insurance policy you hold and the terms of that policy and will often involve something of an uphill battle with your insurance company but, nonetheless, this is the first avenue that you should explore.

Self-Pay Patients
If you do not have health insurance, or, your insurance does not cover weight loss surgery, you will need to pay it by yourself. This is referred to as being a self-pay patient. Hospitals offer payment plans for some services allowing you to make payments towards some or all of your expenses rather than being charged in one lump sum. Another option is to pursue private financing from a lender for your medical expenses, but as with any other type of personal loan, you will need to consider the finance charges (interest rate) and fees.

Gastric Bypass and Health Insurance
Whether or not the procedure and related costs are covered by health insurance depends on your insurance company, your state, and your specific policy, among other factors.
It is important that you review your policy or speak with your insurance company directly to determine if you are covered. Some insurance plans explicitly exclude obesity treatment, weight loss surgery and related care, which means that they will not cover any related charges you may incur from preparing for, having, or recovering from your gastric bypass procedure.

The Pre-authorization Process
You will need to see your primary care physician if you are covered by an HMO to obtain his approval before seeing a specialist like a bariatric surgeon. Once you have seen the specialist and have been deemed a candidate for weight loss surgery, you will need to begin the pre-authorization process.

The approval process for weight loss surgery is more complicated than other medical procedures. The insurance company will request both your physician and surgeon send a letter of medical necessity as part of the weight loss surgery pre-authorization process. The doctors will relate to the insurance company how having the procedure will improve your health and overall well-being.

At this time insurance company will consider your request, whether the authorization will be approved, denied, or the insurance company will request additional information. If you are denied pre-authorization by your insurance company, you can appeal the decision. All insurance plans offer an appeals process and they are legally obligated to disclose to you your right to appeal. You are typically allowed a 30 to 60 day window from the date you were denied to appeal. The process usually begins with a letter of appeal being sent in to the insurance company by you, your surgeon and your primary care provider.

Medicare Coverage May be Available
If you are on Medicare, a portion of the costs of gastric bypass surgery and related care may be covered, but only if you are both obese and suffer from an obesity-related disease such as type 2 diabetes or coronary heart disease. For the expenses to be covered, you must have the procedure at a Medicare-approved facility.
Medicare does not cover weight loss surgery for patients who are overweight but do not have any of the specified related health problems, even if a doctor has officially diagnosed the patient as being obese. Contact your regional Medicare office to learn more.

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