Cost, Insurance Guide for Gastric Sleeve Surgery
Understanding the costs of weight loss surgery is an essential step in preparing to decide whether the gastric sleeve is right for you. The overall cost of gastric sleeve surgery will depend on the location that the operation is being administered, whether you have insurance, and have the bariatric coverage, and which surgeon you choose.
Gastric sleeve surgery is a bariatric procedure that removes a portion of the stomach to promote weight loss in patients. Patient experience rapid weight loss and feel less hungry after their system. This is because the stomach is smaller and the portion of the stomach that produces the hunger hormone, Ghrelin, is removed during surgery. The gastric sleeve also is safer than other weight loss treatment with less risk of infection and other serious complications post-op.
Average Costs of Gastric Sleeve Surgery
The price of gastric sleeve surgery falls in between the costs of both the gastric band and gastric bypass weight loss surgery costs. According to our internal study, the average cost of gastric sleeve surgery in 2017 in the United States is $14,800 to $15,000, more than $2,000 less than subsequent years.
This is the amount of money that a patient would pay without any insurance coverage/support. The cost of surgery for an insured patient would depend on their coverage and their particular insurance company. For more information on the specifics, a patient should contact their insurance company directly to get a cost write-up from them.
Cost of Gastric Sleeve in Various Countries & States
The cost of gastric sleeve surgery will vary in different states and countries. Just because the cost of operation is lower somewhere doesn’t mean that that bariatric surgeon is any less skilled. The price is determined by either the hospital or facility the surgery is being performed at or the surgeon itself and their fee. They may opt for a lower price to encourage more people to choose to have the surgery and make it more available to those that may not have insurance coverage.
The average cost of Gastric Sleeve surgery in Canada is CAD 19,625 (approximately USD 14,800), AUD 4,200 in Australia (USD 3,139), and 11,100 Euros in the United Kingdom (USD 11,928).[2] Traveling to Mexico may yield an average cost of about one-third of the price of the surgery in the United States and Canada from $5,000 to $8,000.[3]
State Breakdown
The Bariatric Surgery Source reports that gastric sleeve costs are the lowest in Texas, Nevada, Arkansas, and Oklahoma in all of the 50 states.
The cost of gastric sleeve surgery varies by state. In New York City (New York), the average price is $19,000, much higher than the country average. In Los Angeles, California, the average price is $16,000 just like Chicago, Illinois. However, in Wichita Kansas, the average cost is only $12,000 and $11,000 in Atlanta, Georgia. The highest average seems to be in Boston, Massachusetts at $25,000 and Phoenix, Arizona at $23,000.
Surgeon/Center Location Cost
| $13,900 package | Princeton, NJ | Dr. Vishal Mahta |
| $13,000 | Riverside, CA | Riverside Surgical |
| $11,900 package (cash pay) | Birmingham, AL | Alabama Weight Loss Center |
| $9,995 (no insurance) | Edmond, OK | WeightWise Bariatric Program |
| $4,100 | Mexico | Florence Direct Care |
Price information as of December 2017:
Cost of Gastric Sleeve Surgery Breakdown
Ultimately the gastric sleeve surgery involves the work of countless medical professionals to go unhitched. Here we will break down the costs associated with this weight loss surgery.
Pre-Op/Before Surgery
Bariatric Surgery Source reports a series of different pre-op and before surgery costs. This include (and are not limited to):
Dietitian/nutritionist consultations (to determine the patient is ready for a change and has tried to lose weight in the past and have failed)
- Psychologist/Psychiatrist (Mental health clearance for surgery)
- Cardiologist (Heart health clearance)
- Lab/blood work, X-ray fees, Echocardiogram (ECG or EKG)
- Sleep study
- Physician-supervised weight loss program (required for most insurance companies)
- Surgeon consultation fees[5]
During Surgery
Cedar-Sinai Hospital Marina Del Ray Hospital includes these costs as standard surgery costs associated with gastric sleeve surgery. They include:
- Weight Loss Surgeon Fees
- Hospital fees
- Anesthesia fees
- Operating Room Fees
- Surgical assistant fees[6]
Other non-standard expenses that may occur during operation include radiologist fees and pathologist fees for reviewing biopsies if necessary.
Post-Op/After Surgery
Post-Op or after surgery costs can vary from patient to patient. However, some of the most common charges include vitamins, follow-up doctor visits, any visits associated with complications that may occur, gym membership, new clothes and plastic surgery costs to remove sagging skin (if necessary or desired).
Ultimately it is important always to take time to research the costs associated with gastric sleeve surgery or any other surgery, therefore. Ask questions that will make your decision easier for both your chosen bariatric surgeon and your insurance company, if applicable. Before committing to gastric sleeve surgery, make sure that you fully comprehend all the financial responsibilities associated with the procedure.
Which Insurers Cover Gastric Sleeve Surgery?
Here is a list of some insurers that cover gastric sleeve surgery as the publication of this guide.
- Aetna
- Anthem BCBS
- BCBS Alabama, Arkansas, Fed and Florida, Kansas City, Texas, Illinois
- BCBS of Louisiana HMO
- BCBS Massachusetts
- Blue Cross Blue Shield of Michigan
- Blue Cross of California
- Blue Cross Minnesota
- Blue Cross Nebraska
- Blue Cross New York Excellus
- Blue Cross North Carolina
- Blue Cross South Carolina
- Blue Cross Tennessee including State Employees and St. Thomas and Baptist Employees
- CHAMPVA
- Cigna, Cigna-HealthSpring PPO, Cigna State of Tennessee Employees
- Coventry Health Care
- Definity Health
- First Health
- Great-West Healthcare
- Health Spring PPO & Medicare Plus
- Horizon Blue Cross of New Jersey
- Humana & Humana HCA Employees
- Kaiser Permanente
- Medicare / Medicaid
- TennCare Americhoice
- Tricare North, South & West
- Tufts
- Unicare
- United Healthcare
Ultimately, each patient’s health is different, so each insurance company may feel that the surgery may or may not be beneficial for each patient. Never assume anything about insurance coverage. Always get everything in writing. Contact the insurer with any questions you have about coverage and the requirements associated with approval for gastric sleeve weight loss surgery. While your weight loss surgeon is a good source of information, it is your responsibility to get all of the specifics regarding your coverage.
What are the General Requirements Typically Required for Insurance?
United Healthcare (as well as other insurers) have some necessary requirements associated with approval for weight loss surgery including the gastric sleeve. These requirements include:
- Body mass index (BMI) required confirmed by a medical professional
- Usually, the BMI must be over 40 or over 35 with one or more of the following co-morbidities including heart disease, obstructive sleep apnea, hypertension, Type II Diabetes or other health issues related to their obesity.
- Must complete a specific time with a medically-supervised diet program
- Must have a consultation with a bariatric surgeon who believes the patient is capable of surgery
- Must get a medical clearance letter from their primary care physician
- Must get mental health clearance
- Must schedule a nutritional evaluation with a registered dietitian[8]
After these things are done and sent to the insurance company, they will review your detailed medical history and the documentation to determine your eligibility for the surgery. It’s important to note that each insurance company will have specific requirements and pre-op test requirements. Make sure you understand these things thoroughly before applying for insurance coverage for your gastric sleeve surgery.
The review process takes just under one month. The insurance company will send an approval or denial letter. If approved, your bariatric surgeon will contact you to schedule you for your gastric sleeve surgery. If you are denied, you can choose to appeal the denial. A lot of the work will be done by your surgeon’s office who can attest to your need for the surgery.
Does Medicare, Medicaid Cover Gastric Sleeve?
Medicare reports that they do cover some bariatric surgical procedures. The cost may change if you are inpatient or outpatient. Patients can log-in to your profile on Medicare.gov to read a Medicare Summary Notice to see if they have met their deductibles. Part A deductible applies if someone is admitted to the hospital while Part B is for doctor’s visits and outpatient care. Individuals will need to pay their deductible amounts before Medicare begins to pay for any health care, not the just gastric sleeve.[9]
Regarding Medicaid, obesity-related services that help to prevent and manage unhealthy weight are covered. Patients must fit the criteria of the state that they live in. While bariatric surgery is not set out in the guidelines of coverage, each patient is handled on a case-by-case basis. Full coverage is available.[10]
Gastric Sleeve Cost Without Insurance Options
Just because you don’t have insurance coverage for your weight loss surgery doesn’t mean you can’t find affordable ways to finance the surgery yourself. Here are a few of our suggestions on having surgery without insurance.
Consider a medical loan. Many bariatric surgeons work with companies that offer patients loan to have the surgery that they don’t have insurance coverage for.
Apply for Medicaid. Some people are eligible and don’t even realize it. Check to make sure your particular state covers weight loss surgery before switching (if applicable).
Individual states have laws that require an insurance company to cover weight loss if the patient meets the NIH health criteria. Check to see if your country is one of them.
Also, some surgeons may lower the cost if you are paying on your own without insurance. Also, ask if they work with different hospitals as the cost of one hospital may vary from another. Some surgeons even include all pre-op expenses in their quoted fees, so if you’re paying on your own, you can save money here too.
Gastric Sleeve Financing Options
Financing can be used to finance the entire cost of surgery or for the portion that insurance doesn’t cover. Some options include:
- Payment plan through the surgeon
- Unsecured Medical Loans
- Secured Medical Loans
- Permanent Life Insurance Loans
- Retirement Plan Loans
Gastric Sleeve Surgery Abroad
A new trend has emerged: individuals choose to endure gastric sleeve surgery aboard such as in Mexico, South America, and Europe. This process of traveling to undergo medical treatment, usually for less cost is called Medical Tourism. The proponents of this phenomena claim that board-certified weight loss surgeons offer the same procedure for a fraction of the cost as in the United States and Canada.
Many claims that the average cost of surgery there is between $5,000 to $8,000.[11] They also partner with financing firms for individuals who want to work out a payment plan. In Mexico, patients from 16 to 65 years old can opt to have weight loss surgery. The requirements are somewhat similar, however, according to the center, individuals with a BMI of at least 30 can have gastric sleeve surgery (unlike the United States with 35-40).
How to Pick a Good Surgeon Abroad: Choose a board-certified surgeon. This surgeon will be partnering with your primary care physician at home to ensure your best post-op experience. Surgery cost is associated with a package that sometimes can even include the hotel required before traveling back to your home state. Airfare is not included in the price. Although, the trend is growing
Tax Deductions for Gastric Sleeve Surgery
Thankfully in the United States, weight loss surgery is tax deductible if the expenses are more than 10% of your adjusted gross income. [12] This is done on Schedule A of a patient’s 1040 form. Save all medical bills and payment statements for adequate proof of the costs incurred throughout that tax year.
Conclusion
Overall, the cost of gastric sleeve surgery will vary on your location. By taking adequate time to research all of the associated costs, you can make an informed decision for yourself. Whether you have insurance coverage or if your insurer pays a specific amount will determine your overall plan to financing your weight loss surgery. Weight loss surgery aboard is an excellent option for individuals who want to save money on their operation or are uninsured.
With a variety of options available for gastric sleeve surgery, many patients who want to manage their obesity with weight loss surgery can successfully do so.
