The Cost of Surgical Weight Loss: What to Expect

Weight loss surgery, also called bariatric or metabolic surgery, is a treatment option for people with obesity who have taken other measures to lose weight with minimal success. The procedure can help people significantly reduce their weight and improve their overall health.

The cost of bariatric surgery varies depending on the type of surgery, your insurance coverage, and the hospital in which it’s performed.

Read on to learn more about the cost, insurance coverage, and financing plans for surgical weight loss.

Because obesity puts people at risk for additional health conditions, many insurance companies cover bariatric surgery if you qualify. You may need to meet the National Institutes of Health (NIH) criteria to qualify for insurance coverage. Some states require insurance companies to cover weight loss surgery if you meet these health criteria.

Some insurance plans cover the full or partial cost of surgical weight loss procedures. Coverage can vary depending on your state and the reason for the surgery. You may be responsible for covering certain costs or a percentage of the surgery.

Questions to ask your insurance company can include:

  • What type of coverage does my current plan offer?
  • Which type of bariatric procedures does my plan cover?
  • What are the eligibility criteria for weight loss surgery?
  • What information does the company require to authorize coverage?

Surgical weight loss financing plans are available. Some options include loans and payments via a third-party credit company. Some hospitals may offer package options if you plan to pay out of pocket.

Obesity is linked to a higher cost of living, including medical costs. People who are obese often spend more on medical care, medications, and insurance. Obesity is linked to several chronic health conditions, including heart disease, type 2 diabetes, and high blood pressure, which can increase healthcare costs.

Dr. Peter Nau, a bariatric surgeon at the University of Iowa, says, “While weight loss surgery certainly isn’t cheap, it’s far more expensive to not have the surgery, otherwise insurance wouldn’t pay for it. The insurance companies save money since patients are healthier.”

Nau also notes that obesity can lower income and productivity. “The [rate of] absenteeism associated with obesity is huge,” he says. “Obesity is a significant cause of loss of work and not being productive while you are at work.

“Plus, if a person has type 2 diabetes, and you’re on 100 units of insulin and two oral medications, it can be financially devastating, depending on how much they have to pay out of pocket.

“While surgery may not cure their diabetes, to take them from 100 units of insulin and two oral medications to just one medication can make a huge difference in their cost,” Nau says.

Success rates of surgical weight loss vary depending on the type of surgery. Some studies suggest that people lose 15% to 30% of their total body weight, though some of it is regained.

Research from 2017 suggests that people may lose 60% to 70% of their excess weight.

To maintain weight loss, you’ll need to adopt healthy lifestyle habits and follow the diet and exercise plan your surgeon recommends. Major weight loss can positively impact your quality of life and reduce health concerns. You may feel better overall and find it easier to do certain activities.

“More than 95% of people will successfully lose at least half of their extra body weight and the majority will keep it off. However, numbers don’t necessarily define success, and that’s really the case for the majority of the people,” Nau says.

“I tell my patient that we don’t define their success. It’s really about what they consider to be a success,” he adds. “It may be the resolution of a clinical condition like type 2 diabetes or high blood pressure. For other people, it’s doing something, whether it’s getting on that roller coaster or getting on a plane.”

To get started with surgical weight loss, you’ll want to do research and talk with at least two surgeons. If you can, consider attending an in-person or online seminar to learn more about the process.

Also, you’ll need to see if you meet the criteria of your insurance coverage. This might include having a specific body mass index (BMI) and obesity-related conditions.

Check to see which hospitals your plan covers. You can also find out whether you need a referral from your primary care physician and provide information regarding your medical history. You may also need to provide evidence that other weight loss methods were not effective.

Is surgery a good weight loss option?

“I don’t think there’s any question that it’s the best weight loss option. There’s no evidence to support anything else and the reality of it is that the majority of people can’t lose weight on their own. It doesn’t mean they’re not trying; it means that obesity is complicated,” says Nau.

Does Medicare pay for weight loss surgery?

Medicare will cover weight loss surgery for people who meet the criteria, which include having a BMI of 35, having one obesity-related condition, and experiencing unsuccessful attempts at weight loss.

Does Medicaid cover weight loss surgery?

Yes, Medicaid covers weight loss surgery.

When is surgical weight loss medically necessary?

“Weight loss surgery isn’t medically necessary in the sense that you won’t live if you don’t do it. However, if people are struggling with obesity and related health conditions and can’t get on top of it on their own, they should consider weight loss surgery as an option,” Nau says.

Bariatric surgery is a good weight loss option for people who meet the criteria. If you’re considering surgical weight loss, there are many cost-related factors to think about. If you have insurance, you’ll want to find out what your plan covers and see whether you’re a candidate.

To learn more, talk with at least two bariatric surgeons and attend an in-person or online seminar. With plenty of information, you’ll be able to make the best decision for you.

https://www.healthline.com/health/surgical-weight-loss-cost