How Much Does Bariatric Surgery Cost?

Does Insurance Cover Bariatric Surgery?

Many insurance companies, including Medicare, provide bariatric surgery as a covered benefit.  But it is up to the employer to elect bariatric coverage for their employees.  Other than Medicare, Medicare replacement policies, or Medicaid, individual policies purchased through a broker or the Marketplace do not cover bariatric surgery.   

If your policy covers bariatric surgery cost, there will be some specific criteria for coverage which may include some or all of the following:

• Age 18 or older (younger than 18, consult with your child’s pediatrician)

• Body mass index (BMI) over 40; or BMI over 35 with Type 2 diabetes, high blood pressure, obstructive sleep apnea; or other risk factors

• Proven weight-loss efforts in the past

• Letter of medical necessity 

• Smoking cessation before surgery

• No active substance abuse

• Psychological testing/Nutritional counseling

• Documented attempt(s) with a medically managed weight-loss program.

• Morbid obesity diagnosis for a period before surgery.

For those interested in obtaining more information about their insurance coverage and the criteria necessary to qualify, a bariatric insurance coordinator who is well-versed in this specialty, can check your current benefits for coverage. If coverage exists, they will let you know what steps you will need to complete before insurance approval and your approximate out-of-pocket costs. 

At Flagler Health+ Surgical Specialists, Dr. Robert Marema has had the same insurance expert for the last 9 years. Kathleen Rogers is an expert at knowing the ins and outs of the insurance world as it applies to bariatric surgery coverage. She can be reached at 904-819-5861, option 7. 

It is important to know what your insurance benefits are and how to pay for weight loss surgery before you can decide on how to explore it as an option. When insurance doesn’t cover bariatric surgery, this does not mean that you shouldn’t consider it. For many people, it is a medically necessary intervention, not simply about looking better. It is life-saving, life-extending and drastically improves one’s quality of life. 

When people have exclusions for bariatric surgery on their insurance policy, creative options can be sought to pay for the procedure out of pocket. This is an important factor since the average cost of bariatric surgery without insurance or even the average cost of gastric bypass without insurance can be out of reach for most people. Some standard options include a health savings account (HSA) or flexible spending account (FSA) to pay for bariatric surgery. Others may borrow from their 401K, use their home equity in a Home Equity Loan, or seek a personal loan from their financial institution, or combine several credit cards for payment.   

Another common solution for financing is through financial companies such as Prosper or CareCredit. CareCredit is like your typical credit card company. You can apply through their website. Prosper Financial is a loan company that you can also apply for on their website. Do your research before applying for any loan.  

When paying cash for bariatric surgery, this can qualify as a medical expense you can claim on your taxes to reduce your tax burden. Aside from the surgery, you can also claim the supplements and medications you buy throughout the year to avail yourself of some tax deductions. 

Get Bariatric Weight Loss at Flagler Health+

Flagler Health+ Surgical Specialists can govern your bariatric surgery in their top-notch Bariatric Surgery Center. Flagler Health+ features a world-renowned bariatric surgeon, Dr. Robert T. Marema, with vast experience in laparoscopic gastric bypass, sleeve gastrectomy, and laparoscopic revisions. With three decades of experience, Dr. Marema and his team of specialists, deliver world-class care and a complete multidisciplinary education program that addresses all of the lifestyle components to achieve your desired results!