4 Ways to Reduce Your Bariatric Surgery Cost

By:  

Jeffrey A. QuinlanCEO & Editor-in-Chief of Bariatric Surgery Source

Last Updated:  

08/10/2021

Your bariatric surgery cost can be lowered in 4 ways:

1. Your medical insurance can pay for it
2. You can ensure that your surgeon offers competitive pricing vs. other practices
3. You can get a medical loan with affordable monthly payments
4. You can see if you qualify for tax write-offs

Read below to learn everything you need to know about paying for bariatric surgery

TABLE OF CONTENTS

Click on any of the topics below to jump directly to that section

1. Cost With Insurance
2. Cost Without Insurance
3. Cost by Location
4. Cost Vs Not Having Surgery
5. Cost Breakdown
6. Financing Options
7. Tax Write-Offs
8. Insurance Check Cost Quote

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Cost With Insurance

Click your country below for weight loss surgery insurance information:

United States: Weight Loss Surgery Is Covered by Some Medical Insurance Plans

In the U.S., the following procedures are covered by insurance, but only if your specific policy includes it:

• Gastric sleeve
• Gastric bypass
• Duodenal switch
• Lap-Band

Gastric balloon and the AspireAssist Device are currently not covered by insurance in the United States.

Use our Check My Insurance Tool to find out if it’s covered by your plan:

How Do You Know If Your Insurance Includes Weight Loss Surgery?

It depends on where you get your insurance:

1. Individual/Family Plans & Small Group Plans (under 50 employees) – The Affordable Care Act (Obamacare) requires bariatric surgery coverage in many states.
2. Large Group Plans (50+ employees) – Your company decides whether weight loss surgery is covered. Talk with your HR department or contact your insurance company to find out if it’s covered.
3. Medicare & Medicaid – Medicare and Medicaid both cover gastric bypass surgery, but not all surgeons accept them.

Use the Check My Insurance Tool at the top of this section to find out if your plan includes weight loss surgery.

If Your Policy Covers It: Ask for a Free Insurance Check

Many surgeons offer a free insurance check. They have a staff that is experienced at working with insurance companies.

Rather than figuring it out on our own, talk with a surgeon’s office about doing the legwork for you.

Contact a surgeon for a free insurance check.

Following are average bariatric surgery costs by procedure and plan type, after insurance pays:

• 4-Way Tie: Gastric sleeve, gastric bypass, duodenal switch, and Lap-Band: $3,500
• Gastric balloon: $8,248 (usually not covered by insurance)
• AspireAssist Device: $10,626 (usually not covered by insurance)

• No money has been paid towards your calendar year deductible for other services
• Calculations made using special formulas that take into account the average plan designs from Kaiser Family Foundation’s Annual Employer Health Benefits Survey (3)

Your final out of pocket cost after insurance depends on several factors, including:

• Discounts Negotiated By Your Insurance Company

  Insurance companies often have pre-negotiated rates for doctors and hospitals in their network. They may also try to negotiate deeper discounts on top of any negotiated rates.

• Calendar Year Deductible Level

  You must pay all medical costs until you reach your calendar year deductible amount. Some expenses, like copayments and prescriptions, do not count towards your deductible. Prescriptions may have their own Calendar Year Deductible.

  After you reach the deductible, you share the cost with the insurance company. The amount you share depends on your Coinsurance percentage (see below).

  Deductibles reset on January 1st. As a result, many weight loss surgery patients “rush” to get a surgery date before the end of each year.

• Remaining Calendar Year Deductible Amount

  The amount of money you still owe towards your deductible.

• Hospital Copay

  The amount you will pay for each hospitalization (including weight loss surgery). Does not count towards reaching the Calendar Year Deductible.

• Hospital Coinsurance

  The percentage of the total bill you are required to pay after you have “paid off” your Calendar Year Deductible.

• Out of Pocket Maximum

  This is the most you will have to pay through deductible and coinsurance before your plan pays 100%. You will still be responsible for copayments, such as:

  • Office visits
  • Hospital copays
  • Prescription drugs
• Total Year-to-Date Coinsurance Paid

  The total amount of coinsurance you have paid so far this calendar year. This is needed to determine whether your weight loss procedure will cause you to reach your annual out of pocket maximum.

If Your Policy Does NOT Cover Weight Loss Surgery, You Should Seek Partial Coverage

You may be able to get part of the costs paid for by insurance even if weight loss surgery isn’t covered. It’s all about how your doctor and hospital submit your claims to your insurance company.

For example, there are many non-bariatric surgery reasons for your doctor to recommend:

• Cardiology exam
• Lab work
• Medically supervised diet program
• Psychological exam
• Sleep study

These are ordered for many reasons other than bariatric surgery and may be covered as a result. If your doctor submits one of these claims using a weight loss surgery CPT code (Current Procedural Terminology Code), your insurance is unlikely to cover it. But if your doctor uses a general CPT code, it probably will be covered.

While this may sound “sneaky”, it is an ethical practice. After all, these tests will be beneficial regardless of whether you move forward with surgery.

Find a Weight Loss Surgeon

The U.S. Insurance Approval Process

The entire bariatric surgery insurance approval process takes between 1 and 12 months.

The approval process usually happens in these steps:

1. Your body mass index (BMI) requirements are confirmed by your physician:
   • BMI over 40 –OR–
   • BMI over 35 with one or more of the following:
     • Clinically significant obstructive sleep apnea
     • Coronary heart disease
     • Medically refractory hypertension
     • Type 2 diabetes mellitus
     • Other obesity-related health issues
2. Complete 3 to 7 consecutive months of a medically supervised diet program.
3. Schedule a consultation with your bariatric surgeon.
4. Schedule a consultation with your primary care physician to get a medical clearance letter.
5. Schedule a psychiatric evaluation to get a mental health clearance letter.
6. Schedule a nutritional evaluation from a Registered Dietitian.
7. Send the following to your insurance company:
   • All the above documentation
   • Detailed history of your obesity-related health problems
   • Difficulties and treatment attempts
8. The review process usually happens in under one month.
9. Insurance company sends approval or denial letter:
   • If approved, your surgeon’s bariatric coordinator will contact you for scheduling.
   • If denied, you can choose to appeal the denial.

Your bariatric surgeon’s office will do most of this legwork for you. They may even have all the required people on staff (registered dietitian, psychiatrist, bariatric coordinator, etc.).

For more information about gastric bypass insurance, see our Bariatric Surgery Insurance Patient Guide.

Disability Insurance During Recovery

Your employer decides whether to offer Disability insurance (DI). You can continue coverage as an individual if you leave the company.

DI pays you a percentage of your monthly income if you are unable to work. Short term disability insurance (STD) usually pays 2/3 of your salary for the first 90 or 180 days of your recovery.

Disability insurance usually includes pre-existing conditions limitations. The best way around this is to sign up during the initial enrollment period (when you’re hired). They might not allow you to enroll at any other time. You then need to stay enrolled for the entire “pre-existing conditions exclusionary period,” which lasts between 6 and 12 months.

Call your insurance company, talk with HR, or review your plan documents for details.

Cost Without Insurance

If you don’t have insurance and ask a surgeon for a bariatric surgery quote, you will get one of 3 responses:

• No Self-Pay Option – Some practices only work with patients who have insurance.
• Partial Quote – Some practices only quote the surgeon’s and surgeon assistant’s fees. They don’t know the cost of services that are not under their direct control, like hospital fees. Most of these surgeons can provide phone numbers for you to conduct that cost research on your own.
• All-Inclusive Packages – Many practices quote an up-front, all-inclusive cost. If any costs are not included in the package, they should outline those as well. These programs often include between 3 and 13 months of follow up visits in the packaged price.

Approximate self-pay costs for each weight loss procedure are as follows (click links for more information):

• Gastric Sleeve: $19,000
• Gastric Bypass: $24,000
• LAP-BAND^®: $15,000
• Duodenal Switch: $27,000
• Gastric Balloon: $8,000
• AspireAssist: $11,000

Click here to find a weight loss surgeon to ask for a self-pay quote.

How to Get Weight Loss Surgery Insurance in the U.S.

There are 2 ways to get weight loss surgery insurance if you don’t already have it:

• The Affordable Care Act (“Obamacare”) requires insurance companies to include weight loss surgery coverage in some states. You may be able to sign up for one of these plans. See our Obamacare page for more information.
• Convince your company to add it to your plan. If you work for a company with 50 or more employees, they decide if your plan includes bariatric surgery. There are many good business reasons for adding it that they may respond well to. Click here for information to share with your HR department.

Discounts: 6 Discounts to Ask Your Surgeon About

Talk with your surgeon about whether any of these discounts are available:

1. Self-Pay Discounts. Most surgeons offer self-pay discounts or payment plans. Just ask!
2. Other Discounts. Some offer discounts if you pay the total amount in advance.
3. Same Surgeon, Different Hospitals. Some surgeons operate at more than one hospital. Hospital costs make up the biggest part of the bill, so find out if your surgeon has a choice.
4. Pre-Op Costs. Some surgeons include pre-op costs in their quoted fees. Pre-op costs include things like testing and office visits.
5. Complications. Should they arise, may increase total costs. Ask your surgeon who will pay if a complication arises during surgery. Some surgeons will include the cost of any complications in their quote while others will charge extra.
6. Health Insurance That Does Not Include Bariatric Surgery. You may still get insurance to pay for some costs that could be applied to covered treatments. For example, lab work is needed for many reasons outside of bariatric surgery. Your surgeon can help you find the loopholes in your plan.

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Cost Without Insurance – By Location

CLICK HERE: To see how much bariatric surgery costs in your area

Your total weight loss surgery cost depends on which procedure you choose and where you have the surgery. This varies widely by surgeon and hospital. Different surgeons in the same city can have a price difference of $5,000 to $10,000 or more.

Note that cost often has nothing to do with the quality of the surgeon or hospital. Instead, cost is driven by:

• Cost of living in the area
• Local competition
• Local Medicare and Medicaid populations
• For-profit or non-profit status of the hospital used

This section shares average costs by location for each procedure.

For a specific price in your location, click here to contact a surgeon and ask for a free quote.

United States: $8,248 to 27,324

The average cost of bariatric surgery in the United States ranges from $8,248 to $27,324 depending on the procedure:

1. Gastric balloon: $8,248
2. AspireAssist Device: $10,626
3. Lap-Band: $15,180
4. Gastric sleeve: $19,228
5. Gastric bypass: $24,288
6. Duodenal switch: $27,324

But there is a big cost difference between states. For example, gastric sleeve surgery averages $19,228 but ranges from $12,144 in Nevada to $58,696 in Alaska.

For state averages for each procedure, scroll through the chart below. You can sort the table alphabetically by state or from lowest cost to highest cost states.

For an exact quote, click here to find and contact a surgeon.

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United Kingdom: £4,048 to £11,132

Following are the total average bariatric surgery costs in the United Kingdom by procedure:

• Gastric balloon: £4,048
• Lap-Band: £5,055
• Gastric sleeve: £10,120
• Gastric bypass: £10,120
• Duodenal switch: £11,132

For an exact quote, click here to find and contact a surgeon.

International (Medical Travel): $4,048 to $27,324 USD

Following are average weight loss surgery costs by country for each procedure (in U.S. Dollars):

Click here for an in-depth review of medical travel for weight loss surgery.

Cost Vs Remaining Obese

Starting 13 months after weight loss surgery, patients without insurance save about $900 per month due to reduced medical costs (1). That’s almost $11,000 saved per year.

Fewer prescription drugs alone save patients $3,000 or more per year (2).

In other words, depending on your final procedure costs, you should “break even” within 2 years and start saving $11,000 per year.

This applies only to the more involved procedure that do a better job improving health issues, including:

• Gastric sleeve
• Gastric bypass
• Duodenal switch
• Lap-Band

The other remove procedures – gastric balloon and the AspireAssist Device – improve health but not to the same degree. And there are no studies to check long-term cost savings associated with them.

Bariatric Surgery Cost Breakdown

Pre-Op (Costs Before Surgery)

• Physician-supervised weight loss program (required)
• Dietitian/nutritionist consultations
• Psychologist (mental health clearance)
• Cardiologist (heart health clearance)
• Lab/blood work, echocardiogram (also known as an “ECG” or “EKG”) and/or X-Ray fees
• Surgeon consultation fees
• Sleep study

Standard Costs During Surgery

• Hospital fees
• Surgeon fees
• Surgical assistant fees
• Anesthesia fees
• Operating room fees
• Device costs

Non-Standard Costs During Surgery

• Pathologist fees (for reviewing biopsies, if necessary)
• Radiologist fees (for reviewing x-rays, if necessary)

Post-Op (Costs After Surgery)

• Addressing any complications
• Follow-up doctor visits
• Bariatric vitamins
• Extra food costs (healthier food tends to cost more)
• Personal trainer and/or gym membership
• New clothes (wait to go crazy with this until you reach your plateau weight)
• Plastic surgery to remove sagging skin (more on this in the Downsides section below)

Financing Options

Weight loss surgery financing is available almost everywhere. It helps pay for:

• The entire cost of your surgery if your health insurance doesn’t cover it
• The part that insurance doesn’t cover, like deductibles, copays, or coinsurance

Financing options to make bariatric surgery more affordable include:

1. Payment Plan Through a Qualified Surgeon
2. Brokers, Direct Lenders, and Credit Cards (Unsecured Medical Loans)
3. Friends & Family
4. Secured Medical Loans
5. Retirement Plan Loans
6. Permanent Life Insurance Loans
7. Medical travel – having surgery in a location that is less expensive than where you live

Tax Write-Offs

Tax savings might be available to you.

Bariatric Surgery Might Be Tax Deductible, Special Tax-Favored Accounts Available

Weight loss surgery is tax deductible, which can have a big impact on the total cost of surgery.

You can deduct medical expenses if the costs are more than 10% of your adjusted gross income.

To receive the deductions, you’ll need to complete Schedule A of the IRS Form 1040. You’ll also need to save your medical bills and payment statements as proof.

Money in special savings accounts (or even your IRA) may also be a way to pay for part of surgery tax-free:

1. Health Savings Account (HSA)

   You can open an HSA alongside a “qualified high deductible” health plan. Tax-free HSA money can be used pay for qualified medical expenses. No other account receives better tax treatment. You can even transfer IRA money into an HSA. See the IRS’s Site for more info.

2. Archer Medical Savings Account (Archer MSA)

   Archer MSAs are like HSAs for the self-employed or small businesses. Click here for details.

3. Health Reimbursement Account (HRA)

   HRAs are only offered by employers who set them up and contribute money to them. If your company offers one, make sure your plan allows the use of HRA funds to pay for “all qualified medical expenses.” Click here for more info.

4. Flexible Spending Account (FSA)

   Both employers and employees can contribute to an FSA, also known by its IRS code, “Section 125”. Money from them can be taken out tax-free if it is used for qualified medical expenses. Click here to get the summary from the IRS.

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