How much does bariatric surgery cost? | Gastric bypass, gastric sleeve

Key Points

• Average bariatric surgery costs range from $17,000 to $26,000 when you meet eligibility criteria, gain healthcare provider approval, and insurance covers the procedure.
• There are different financing and insurance coverage options that may make weight loss surgery more accessible.
• Learning about weight loss surgery costs and coverage options can help you make an informed decision.

If you're considering weight loss surgery, understanding the costs involved is likely one of your big concerns. 

In this article, we discuss typical costs, insurance coverage, and what financial options may exist if you do not have insurance.

What is bariatric surgery?

Bariatric surgery refers to several types of weight loss procedures that can help people with severe obesity achieve significant and lasting weight loss. According to the Centers for Disease Control and Prevention (CDC), more than 40% of American adults struggle with obesity, with severe obesity affecting nearly 10% of the population.

"Bariatric surgery isn't just about weight loss," explains Gia Eapen, MD. "It can also potentially help with improvements in obesity-related conditions like  type 2 diabetes and hypertension.”

Some common types of bariatric procedures include:

• Gastric Sleeve (Sleeve Gastrectomy): Removes about 80% of the stomach
• Gastric Bypass (Roux-en-Y): Creates a small stomach pouch and reroutes the small intestine
• Gastric Banding: Places an adjustable band around the upper part of the stomach

What is the cost of bariatric surgery procedures?

The average cost of bariatric surgery in the United States typically ranges from $17,000 to $26,000, according to the American Society for Metabolic and Bariatric Surgery (ASMBS).

The costs can include:

• Essential pre-surgical tests and evaluations to ensure you're ready for the procedure
• The main surgical fees that cover your surgeon's expertise and operating room time
• Hospital stay expenses, which vary based on your recovery needs
• Post-surgery care, including follow-up visits and monitoring

Also, remember that costs can vary depending on your location and specific needs

Breaking down weight loss surgery costs

Let's look at what's typically included in a bariatric surgery package using Denver Health, a health system in Colorado, as an example.

Their bariatric surgery cost package includes:

• Pre-operative bariatric care
• Anesthesia services
• Two-day hospital stay
• Surgeon fees
• They even cover your post-operative care for up to 90 days after surgery

At Denver Health, a laparoscopic Roux-en-Y gastric bypass costs around $15,920, while a laparoscopic sleeve gastrectomy is priced at $11,337.

What costs are not covered for weight loss surgery?

It's important to note that a bundle price for weight loss surgery may not cover everything in your weight loss journey. You may need to plan for additional expenses like your initial consultation with the surgeon and bariatric psychology evaluations. There are also potential pre-operative requirements such as cardiac clearance, sleep studies, and laboratory tests.

Visits with a bariatric dietitian, however, may be covered by your insurance.

After surgery, you'll have follow-up visits at six months and one year, plus regular lab work at three months, six months, and one-year post-operation. These costs are separate from your surgical bundle, so be sure to factor them in to understand your total financial commitment.

Knowing what the surgery costs can help you plan ahead and find the best way to manage the expenses. This understanding makes it easier to have productive conversations about payment options and create a realistic financial plan.

Does insurance cover bariatric surgery costs?

Insurance coverage for bariatric surgery depends on your specific plan and insurance carrier. Most insurers require patients to complete physician-supervised weight loss programs before covering the procedure.

"Understanding insurance coverage is crucial," explains Eapen, MD. "Most insurance companies may cover weight loss surgery when specific criteria are met. Talk to your healthcare provider if bariatric surgery is right for you. You may discuss your financial concerns with them as well."

What are the insurance requirements for bariatric surgery?

The following are common insurance requirements for bariatric surgery coverage, though specific criteria can vary by provider. Contact your insurance company directly to understand their particular requirements and approval process.

Insurance requirements can typically include:

• BMI of 40+ or BMI of 35+ with obesity-related conditions
• Documented history of failed weight loss attempts
• Completion of medically supervised weight loss program
• Psychological evaluation
• Medical necessity documentation

Medicare and Medicaid coverage

Medicare covers certain approved procedures like gastric bypass surgery and laparoscopic banding surgery, making it a great option for those who are eligible.

Note: Open sleeve gastrectomy and laparoscopic sleeve gastrectomy procedures are not covered by Medicare, according to the Centers for Medicare & Medicaid Services (CMS).

Most states cover weight loss surgery, but Medicaid rules vary. It’s best to verify the coverages based on your specific state.

Both programs require you to meet certain medical criteria. It's always a good idea to check the exact requirements with your provider to see if you qualify.

Exploring financing options beyond insurance

If insurance doesn't cover bariatric surgery, there may be several other payment options that can help you achieve your weight loss goals.

A personal or medical loan

If you're considering using a personal or medical loan for your bariatric surgery, many financial institutions offer specialized healthcare lending options with competitive interest rates and flexible repayment terms.

While medical loans are specifically designed for healthcare expenses, personal loans can also be a viable option depending on your credit score and financial situation. Just be sure to carefully compare interest rates, repayment periods, and total costs before choosing a lender.

Health Savings Account (HSA) or Flexible Spending Account (FSA)

Using tax-advantaged funds like Health Savings Account (HSA) or Flexible Spending Account (FSA) towards your surgery and related expenses is also a potential option to finance your surgery.

Exploring hospital payment plans

Many hospitals and surgical centers offer flexible payment plans to help make bariatric surgery more accessible.

Borrowing from retirement funds

Borrowing from a retirement fund, such as a 401(k) plan, is typically not recommended. However, it is a potential option that you may consider.

Getting the most out of your weight loss surgery

Finding the financial assistance you need for weight loss surgery and then undergoing the procedure is a large part of the battle. But staying on the path to sustained recovery needs a commitment to diet and lifestyle changes. Plus, your health team may require regular follow-ups to ensure you are on track.

One significant factor for successful recovery is following a bariatric diet after surgery.

The importance of the bariatric diet

"Bariatric surgery is just the start of your weight loss journey," says Eapen, MD. "Long-term success requires a commitment to significant lifestyle changes, especially in how you eat."

Working with a bariatric nutritionist dietitian can help you navigate these dietary changes successfully.

"A weight loss dietitian can personalize the best bariatric diet for you. They will help you understand not just what to eat, but how to eat to maximize your surgery results," explains Eapen, MD. "These experts create unique nutrition plans and provide ongoing support for healthy eating habits that last a lifetime."

Final thoughts

If you're struggling with weight and traditional methods haven't worked, bariatric surgery might be your next step—but understanding the financial aspects is crucial to your decision. Before moving forward, research what's included in surgery packages and verify your insurance coverage. You'll need to confirm you meet both medical qualifications and insurance requirements.

Take time to explore all payment options, whether through insurance or self-pay plans. Remember to consider not just the surgery costs but also long-term care expenses. By thoroughly understanding the financial commitment, you can make an informed choice about whether bariatric surgery is right for you.

Frequently Asked Questions (FAQs)

Will my insurance cover weight loss surgery?

Yes, insurance can cover weight loss surgery. However, coverage can vary by provider and policy. Most major insurance companies cover bariatric surgery when medical necessity criteria are met.

What ongoing costs should I expect?

Plan for supplements, follow-up appointments, lab work, and possible new clothing as you lose weight.

What if I need revision bariatric surgery?

If you're experiencing complications from your initial procedure, approval for revision surgery is often granted due to the medical urgency of your condition. However, if the reason for revision is insufficient weight loss, getting approval can be more challenging and often depends on your insurance provider.

Want to keep the weight off after weight loss surgery? Try working with an expert bariatric dietitian near you.

The views expressed by authors and contributors of such content are not endorsed or approved by Fay and are intended for informational purposes only. The content is reviewed by Fay only to confirm educational value and audience interest. You are encouraged to discuss any questions that you may have about your health with a healthcare provider.