Gastric bypass surgery is considered the gold standard of bariatric surgery. It involves two weight-loss aspects, which are reducing stomach capacity and nutrient malabsorption. It allows the patient every advantage possible to achieve the weight loss they desire.
Nevertheless, it still may not be covered by several insurance companies. In this article, we’ll guide you through the expenses you should know about before opting for gastric bypass surgery.
What This Article Covers:
- Surgery Brief
- Does Insurance Cover Bariatric Surgery?
- Does Medicaid Cover Bariatric Surgery?
- Gastric Bypass Cost
- Gastric Bypass Cost Without Insurance
Before you proceed with any decisions regarding such a significant surgery, you should have knowledge on the operation itself. This would include, how long the gastric bypass procedure is, what kind of equipment your surgeon will be using, what type of anesthesia will be used, recovery time, complications, what you need to support your stomach postoperatively, and so much more.
First, the surgery lasts for about 1-2 hours. Since it involves small incisions into the abdomen, you will be under general anesthesia, and the recovery time is around 3-5 days in the hospital.
The equipment used by your surgeon will depend on the type of gastric bypass you choose to go with. Your diet, on the other hand, will consist mainly of fluids for the first week and multivitamins.
Surgery will entail:
- The surgeon will divide the stomach into a small upper section and a large lower section
- The large lower section is completely removed so that the capacity of your stomach is minimal
- Then, the small stomach pouch will be connected directly to the small intestine. The limited food intake will not undergo complete nutrient absorption. This process results in weight loss and high risk of vitamin and mineral deficiencies.
Does Insurance Cover Bariatric Surgery?
This will depend on your insurance plan. As the rates of severe obesity increase every year, the United States insurance companies have started adding more bariatric surgery options to their insurance coverage.
Of course, insurance typically charges more installments when bariatric surgery is included in the plan coverage.
Does Medicaid Cover Bariatric Surgery?
Medicaid does cover bariatric surgery if you meet specific requirements.
It's not a walk in the park to get approved for bariatric surgery. You must meet the Medicaid criteria in order to qualify for coverage of surgery and associated surgeon visits.
You must know your BMI. In order to be eligible for gastric bypass surgery, you typically need to have a BMI above 40. Sometimes a BMI of 35 is accepted if obesity-related conditions are hindering your health.
You will require documentation from your healthcare provider stating bariatric surgery is necessary. If you have obesity-related conditions, like type 2 diabetes and high blood pressure, you will need to have documents proving that you have tried to manage your conditions and treatment was unsuccessful. Some other documents you may need to include:
- Participated in a medically supervised weight loss program for a specific time period
- Diet and lifestyle change must be readily accepted
- Psychological exam
This information should prove that weight loss surgery is not a cosmetic procedure, but one you require for increased quality of life.
Gastric Bypass Cost
The cost of gastric bypass surgery can range anywhere from $15,000 to $58,000. There are many variables that play a factor in the end price.
The unknown can be overwhelming, so we list some of the variables below and how you can tailor them to your advantage.
The State You Live in
This is a factor that people usually do not consider. Where you reside in the United States affects many parts of your life, including medical bills.
There are some states where bariatric surgery can cost $15,000 to $25,000, while other states can reach $60,000.
If it's possible and your insurance supports it, travel to a cheaper state, such as Utah, Nevada, Texas, Georgia, or Ohio for the time of the surgery. Typically, the maximum cost you will pay in any of these states is around $21,000.
If you live in New Mexico, Oregon or Idaho, cost can be close to $36,000 or more.
The second factor that will heavily weigh on your medical bill are the hospital fees. How long are you staying in the hospital for recovery? This will increase if you have any other conditions that need to monitored and stabilized before and after surgery.
The surgeon fee is usually separated from the hospital fee. It is your choice to have surgery, as well as your decision of which surgeon affiliated with the
hospital you want to perform the surgery.
It's logical to choose the most experienced surgeon with the highest rank and who has performed the largest number of surgeries. Nonetheless, that will come at a price, as surgeon experience and your hospital bill have a strongly proportional relationship.
Gastric bypass is a type of bariatric surgery. The thing is, with the evolution of medicine, there are different types of gastric bypass in order to accommodate patient needs. Each surgery type has pros, cons, and price difference.
Open gastric bypass surgery is the very first variant of this procedure. A large incision is made in order to open the abdomen and access the stomach and intestines. Closure is usually followed by a number of sutures. There are a number of safety reasons why this surgery option may be used over another. This option may be better for some patients with:
- An extremely high BMI
- Significant scar tissue, typically from another surgery
- Certain health conditions
This operation doesn't require extra equipment or expertise with using the equipment. This technique is likely to be less pricey.
Laparoscopic (keyhole) surgery has found its way into almost every surgery in medicine. This technique only requires a few small incisions in order to guide surgical tools with minimal sutures.
This operation can result in less scarring, reduced hospital stay, quicker recovery, and decreased risk of infections.
This operation may require a more experienced surgeon to perform. As a result, it can cost more to go through with laparoscopic gastric bypass.
Mini Gastric Bypass
Mini gastric bypass speaks for itself. It was developed to be less complex with shorter operating times and less re-routing. A stomach tube is made instead of a pouch and the incision sites are specific so that there is less maneuvering of internal organs.
The operation is usually done laparoscopically. With only a few small incisions, resulting in similar weight loss results to the regular gastric bypass procedure. The only downside is that insurance may not recognize this operation under the coverage of a regular bariatric procedure.
Gastric Bypass Revision
Gastric bypass revision is an additional weight loss surgery that is performed years after a patient has had the initial bariatric surgery procedure. It is considered when there are complications with the initial surgery or weight regain occurs in order to correct the issue.
There are different options that can be considered here, such as sclerotherapy, lengthening of the Roux limb, transoral outlet reduction, lap-band addition, candy cane removal, or conversion to duodenal switch surgery.
Gastric Bypass Cost Without Insurance
What if you've tried everything, and you were unable to get approval for gastric bypass surgery through your insurance. There are still some some financial options you may be able to explore.
Hospital Payment Plan
It depends on the hospital you're dealing with, but you might find yourself eligible for a hospital payment plan. This will allow you to pay off the cost of surgery through prolonged installments that you agree on with the hospital financial department.
A medical loan is another option that you can go with. You will need documentation from the hospital and your work to prove that surgery is required for the sake of your overall health. You may want to explore Bariatric Loans, United Medical Credit, or Loan Now.
Explore the different programs available that offer grants for weight loss surgery. You must meet the criteria:
- Approval from a medical provider
- Denied insurance
- Need to contribute to raising funds
To sum up, gastric bypass surgery can cost anywhere from $15,000 to $58,000. There are different variables that come into play, affecting the overall cost of bariatric surgery. You may be able to use some of the variables to your advantage.
When you have planned out your course of action, be prepared for the weight loss journey ahead so that your money is not wasted. You might want to start by understanding the multivitamins for bariatric patients that are required for life after any weight loss surgery.
Did you find our blog helpful? Then consider checking:
- Non-Surgical Bariatric Weight Loss
- Bariatric Surgery Benefits
- Alternatives To Gastric Bypass Surgery
- Where Can I Get Gastric Bypass Surgery?
- Gastric Bypass Facts
- How To Restart Weight Loss After Gastric Bypass
- Weight Requirement For Gastric Bypass
- How Much Weight Loss to Expect With a Gastric Bypass
- Gastric Bypass Long Term Results
- Gastric Bypass And Anemia
**This blog is for information and education purposes only. This information is not intended to substitute professional medical advice, diagnosis, or treatment. Please consult with your physician or another qualified health provider with any questions in regards to a medical condition.