Cost of Duodenal Switch

Does medicare cover bariatric surgery? Do they cover gastric sleeve surgery? Is there a co-pay?

The duodenal switch procedure is a less common surgical procedure prescribed for people who are suffering from obesity, largely because it is indicated most commonly for people who have a BMI on the higher end of the scale.

Average Costs of Duodenal Switch

Duodenal switch is considered to be one of the most expensive of all weight loss surgery options because it combines a combination of two procedures, the gastric bypass with the gastric sleeve. It is not offered by all insurance plans because it is a rarer treatment option for morbid obesity. The average price range for morbid obesity is between $22,000 and $42,000. The average cost for the duodenal switch is around $28,000.

Cost of Duodenal Switch in Various Countries, States

Where you choose to have your surgery can have a huge impact on the bottom line, so make sure that you consider all your options. Here’s a small sampling of the wide price differences you can expect to pay from region to region. Make sure that you look at a few different options when considering when and where to have your duodenal switch performed, and make sure that you choose a physician that you trust and feel comfortable with.

 

Country Average Cost

Canada $31,000

Mexico $7,500

Thailand $14,000

India $12,000

Costa Rica $14,000

United States $28,000

 

State Average Cost

New Jersey $24,000

Nebraska $32,500

Illinois $31,000

 


Cost of Duodenal Switch Broken-Down

It is important to consider everything that is and is not included in the duodenal switch procedure when considering your costs. Your cost will generally include the use of a surgical facility, the time and expertise if your surgeon, the other staff members present in your operating room, time in the operating room, anesthesia required for the procedure and other medications as necessary. There may also be other ancillary costs that are not included in this initial cost of your procedure, such as the cost for pain medications post-surgery, which you will need to pay for out of pocket. You may also need to pay for physician’s co-pays when you follow up with your surgeon or primary care physician after your initial procedure.

Pre-Op and Before Surgery

The pre-op process is important and will prepare you for not only the surgery, but the many changes your body will undergo during and after the procedure. You will go on a strict pre-op diet that will continue into your new lifestyle. You will not be allowed to eat or drink anything for a period immediately before your surgery so that your stomach can be empty during the procedure. Make sure that you are dressed comfortably, and avoid things like contact lenses, jewelry, makeup, perfumes and other unnecessary items. Your surgeon and support staff will perform a routine examination prior to your procedure to make sure you’re in good shape and ready to go.

During Surgery, Surgery

The duodenal switch procedure combines two of the most popular weight loss surgical procedures into one single procedure to maximize weight loss. By reducing your stomach size, removing a portion of your stomach and your gall bladder and rearranging your intestines, your surgeon will ensure that you feel fuller sooner, eat less and secrete fewer hunger causing hormones in general.

Post-Op and After Surgery

After your procedure, you can expect to be in the hospital for between two and three days. Soreness is completely normal during this period, and your physician will provide you with pain medication during your hospital stay. You should take between one and three weeks off work or school to recover at home, and a full recovery will take between four and six weeks. Pain will be manageable, the same as with any laparoscopic surgical procedure. You should slowly transition back to your normal activity, always following your physician’s recommendations.

Which Insurers Cover Duodenal Switch

You’ll want to ensure your healthcare provider will cover your bariatric surgery before you begin the process, so that there are no surprises along the way. Even if you see your insurer here, contact an insurance representative or check your paperwork to ensure you’re covered personally before you book your surgery. This information is subject to change. Some insurers will have precise requirements for who does and does not qualify for the duodenal switch procedure, and you will want to make sure that you meet all the requirements before beginning the weight loss surgery journey.

Aetna Anthem BCBS Blue Cross New York Excellus BCBS Florida
BCBS Illinois BCBS Kansas City BCBS Texas Cigna
Blue Cross of CA BCBS Fed BCBS Massachusetts Blue Cross Maryland Care First
Blue Cross Blue Shield Of Michigan Blue Cross Minnesota Blue Cross Nebraska Horizon Blue Cross of New Jersey
Cigna-HealthSpring PPO TennCare Americhoice Coventry Health Care Definity Health
First Health Great West Healthcare HealthSpring PPO Humana
Humana HCA Employees Kaiser Permanente United Healthcare Medicare

 

This isn’t an exhaustive list, but we do our best to keep it up to date with the newest information regarding insurers and whether they presently allow for duodenal switch procedures. If you do not see an insurer that you know should be here let us know.

Requirements Typically Required for Insurance

For insurance companies that do cover the duodenal switch, you will find that the requirements are usually typically quite similar. What you may notice is that for some insurance companies, the Body Mass Index (BMI) requirement is higher than for other procedures. Some insurance providers will allow you to qualify for the duodenal switch the same way as for any other procedure, while others may have a higher BMI requirement in order to qualify, such as the HealthSpring PPO which requires a BMI more than 60. Typically, however, the requirements to meet for a duodenal switch are as follows for most insurance providers:

  1. You must have either a BMI that exceeds 40, or a BMI that exceeds 35 along with at least one co-morbidity, including but not limited to:
  2. Type 2 Diabetes,
  3. Severe sleep apnea,
  4. Cardiovascular disease (including stroke, angina, hypertension)
  5. Some other life-threatening medical condition that is considered weight-induced.

 

  1. Documented evidence that you have been unsuccessful in losing weight in the past, preferably through your physician. This might include several structured diet programs or a single structured diet plan, but together your attempts at losing weight should span at least six months collectively over a two-year period.

 

  1. You should be 18 years or older. Some insurance providers do allow weight loss surgeries for minors, but there are typically special considerations.

 

  1. Other requirements may also be necessary depending on your insurance, such as undergoing a nutritional or psychological evaluation, consulting a weight loss surgeon prior to applying, and so on. Make sure that you are aware of all the requirements before you start on the journey so that you cover all your bases.

 

Does Medicare, Medicaid Cover Duodenal Switch?

Medicare does cover the duodenal switch procedure, if you meet the health requirements and can provide proof that you have been unsuccessful in your weight loss attempts in the past. It is important to work with your Medicare provider to make sure that you are going through all of the necessary steps prior to booking your procedure so that you do not hit any snags. You will want to make sure that you have all the appropriate documentation and that there are no surprises when you finally do book your surgery.

Duodenal Switch Cost Without Insurance, Self-Pay Options

If you find that your insurance company will not cover your procedure, or if you cannot accomplish coverage because you do not meet the requirements for this particular procedure, all hope is not lost. There are a couple of self-pay options for your consideration as well. If you don’t have the money available in savings to handle the surgery cost, consider loans and payment plans.

  • Loans: Make sure that you talk with your physician in detail to determine exactly what your surgery is going to cost before you take out a loan, that way you are not taking out too much or too little in financing You will want to make sure that you are budgeting for all your expenses, while still having a little left over for incidental expenses and the possibility of complications. If additional recovery time is needed, make sure you have wiggle room on your finances. You should also account for the interest payments you will need to make.

 

  • Payment Plans: Many bariatric surgery centers will also offer payment plans, but ask ahead of time rather than relying on this option. Payment plans allow patients to pay their surgery costs off over time, but sometimes you must put a down payment down first before you can enter into such a payment arrangement. Sometimes the cost is lower for a patient on a payment arrangement, so make sure that you discuss this option with your physician in detail.

 

 

  • Surgery Abroad: Another option that is well worth your consideration is to have your procedure in an exotic country where the costs are lower. Whether you decide that you would rather go to Canada or Mexico, South America or somewhere else entirely, what you’ll find is that the price can vary significantly and so can the experience. For example, one of the most popular destinations to have a duodenal switch procedure done is Mexico where you can have the entire procedure done for between $5,000 and $7,500 rather than the $20,000 to $30,000 that it may cost in the United States. The duodenal switch may cost around $14,000 in Thailand or Costa Rica, or $12,000 in India.

 

Tax Deductions of Duodenal Switch

When trying to save as much money as you possibly can, another consideration you should make is tax deductions. Because obesity is a serious medical condition, when your medical expenses exceed a specific percentage of your adjusted gross income (AGI), you will be able to deduct them when you file your taxes, if you itemize your deductions. These qualified medical expenses can include your duodenal switch procedure, approved weight loss plans, nutritional counseling, physician’s costs and other medical costs as long as they exceed 7.5% of your adjusted gross income. Make sure that you consult a tax professional to ensure you are maximizing this benefit.