Gastric Bypass Surgery: Can I Afford It?

Gastric bypass surgery has become a popular weight loss procedure, and can be considered the gold standard for weight loss surgeries. However, the cost of gastric bypass surgery is sky-high, and this is one of most common factors taken into consideration ahead of surgery.

In the normal digestive process, the food you eat goes down your esophagus and enters the stomach, passes into the small intestine, then into the large intestine, which includes the rectum. In gastric bypass surgery, the stomach is divided, creating a small upper pouch and a larger "remnant" pouch. The small intestine is then made to connect to both. After surgery, your stomach will be smaller, making you feel full more quickly, which will, in turn, cause you to eat less. In addition, the food is redirected; it bypasses most of the stomach as well as the first part of the small intestine. As a result, the food will flow directly into the middle part of the small intestine, thus restricting the absorption of calories.

Cost of Gastric Bypass Surgery

In the United States, the average cost of gastric bypass surgery is $24,000. On average, gastric bypass surgery is the second most expensive out of all the available weight loss surgeries. The total cost that the patient will shell out will depend on the following factors:

• Whether the patient will have an open or laparoscopic surgery – Open gastric bypass surgery is usually more expensive (about $2,500 more) than laparoscopic surgery.
• The hospital where the surgery will take place
• Insurance coverage – If the patient has insurance and the hospital and surgeon are covered by the insurance, it is possible that a discount can be arranged.
• Whether the patient has obtained financing for all or some of the costs
• Particular fees the bariatric surgeon as well as other healthcare professionals charge for the different pre-operative, surgical, and post-operative services

Below are the lists of the pre-operative, surgery, and post-operative services that could have specific fees:

Pre-operative

• Physician-supervised weight loss program
• Psychologist (for mental health clearance)
• Consultation with nutritionists or dietitians
• Cardiologist (for heart health clearance)
• Consultation fees of surgeon
• Pre-op exams and procedures such as blood workups, X-ray, and echocardiogram

During Surgery

• Surgeon fees
• Anesthesia fees
• Surgical assistant fees
• Operating room fees
• Hospital fess

Post-operative

• Follow-up doctor visits
• Management for complications (if there’s any)
• Bariatric vitamins or nutritional supplements – these are some of the necessities for your new life
• Food costs – healthy foods are more expensive
• New clothes – when the patient’s weight has plateaued
• Personal trainer – for those who want to go to the gym for weight training or increasing their activity level
• Plastic or cosmetic surgery – addresses sagging skin due to weight loss

Insurance Coverage

According to one study, the average time frame from considering weight loss surgery to actually undergoing the procedure is 3 years. Thus, there is ample time for a person to determine whether his or her medical insurance will cover the type of weight loss surgery that the patient wants. During this time, patients can learn the specifics of their insurance coverage policies as well.  

 In the past, weight loss surgeries such as gastric bypass surgery were predominantly performed on upper to middle class patients. However, within the last couple of years, insurance companies have been increasing their coverage policies and begun covering weight loss surgeries including gastric bypass. Thus, people who cannot afford to pay $20,000 or more in cash for such surgeries are now able to undergo weight loss procedures with the help of insurance.

Paying for Surgery: Cash or Insurance?

Typically, the best way to go for people who want to undergo gastric bypass surgery is through insurance. However, medical insurance coverage does not always include all procedures.

Coverage depends on the policy, not the insurance carrier. Although most insurance companies offer some coverage on weight loss surgeries, the patient’s individual policy details the inclusions and exclusions. Certain policies specifically exclude weight loss surgeries, while most insurance carriers tend to charge more to incorporate coverage for weight loss surgeries such as gastric bypass. Because of this, patients must check their policies to see if their insurance covers the procedure. Call your insurance company to know what’s included and what’s not.

If your insurance does cover gastric bypass, then you can proceed to find a surgeon. If your insurance company does not cover the procedure, worry not as you still have other options to explore, such as financing options. Gastric bypass financing is offered in most locations. Patients without insurance coverage can get financing for the entire cost of gastric bypass surgery. With insurance, patients can obtain assistance through large deductibles as well as other out-of-pocket expenses.

In certain states, there are bylaws that oblige insurance companies to cover weight loss surgeries if patients meet certain criteria. But at the same time, not all insurance carriers cover the entire procedure. For example, some insurance companies might only cover the gastric bypass surgery but not the hospital stay or anesthesia. On the other hand, there are some insurance companies that do not cover any type of weight loss surgery at all.

Coverage Requirements

Every insurance carrier will require different tests and different documents. A visit to approved specialists will also be required. The specialists can range from an endorsed psychologist to an approved cardiologist. Also, before the insurance provider will cover your gastric bypass surgery, it might require you to present documentation from your physician or surgeon authenticating that a medically supervised weight loss program was not successful. Your insurance provider might require your physician's confirmation that gastric bypass surgery is necessary to improve your health. 

Again, the best thing for you to do is to contact your insurance provider, or if your insurance is provided by your employer, call your Human Resources department for further information. In addition, many surgeons provide a free insurance check to ensure the procedure is covered and check what aspects of the surgery are included or excluded in your policy. Surgeons also have highly-trained staff members who are typically experienced in working with insurance carriers.

Cost of Gastric Bypass Surgery vs Cost of Not Having Gastric Bypass

Although having a gastric bypass surgery is very costly, the long-term expenditures of obesity-related health conditions for those who are morbidly obese and do not undergo gastric bypass are even higher. Patients who have undergone gastric bypass surgery are often able to improve their finances in just over a year after surgery. 

According to a study conducted by the American Journal of Managed Care (AJMC), patients who have had gastric bypass surgery pay as much as $900 less every month as soon as thirteen months after surgery, compared with people who have not had gastric bypass surgery. About $11,000 per year is saved in the total medical costs and food expenses of patients who have undergone gastric bypass surgery, compared with those who are morbidly obese and have not had the surgery. It is clear that patients can save a significant amount of money after they undergo gastric bypass surgery and lose weight.