Cost & Insurance Guide for Gastric Bypass Surgery
Gastric bypass surgery costs can vary between $15,000 and $35,000 depending on a few different variables, and the average price is around $24,300
Gastric bypass surgery costs can recommend between $15,000 and $35,000 depending on a few different variables, and the average cost is about $24,300. There are several important considerations to make when considering gastric bypass surgery costs and whether your insurance carrier will cover this procedure. For example, the procedure is much more cost effective when for.
Cost of Gastric Bypass in Various Countries, States
Where you choose to undergo your gastric bypass surgery can have a profound impact on the bottom line. Here is a look at the cost of gastric bypass in various countries and states on average, for a look at around what you can expect to pay in one region versus another.
Mexico $7,000 – $10,000
Canada $18,900 – $24,000
United States Generally $15,000 – $38,000
Arizona $24,500 – $28,000
California $23,500 – $29,000
Florida $19,300 – $22,400
Georgia $18,000 – $21,000
Louisiana $17,900 – $22,100
Illinois $21,900 – $24,500
Massachusetts $32,000 – $39,400
Nevada $18,400 – $23,300
New York $26,000 – $38,000
Oregon $27,800 – $31,000
Texas $17,800 – $21,500
Washington $19,300 – $34,000
Cost of Gastric Bypass Surgery Broken-down
It is important for you to understand that there are a lot of things that go into the cost of your gastric bypass surgery. Some of the things that are included in your gastric bypass surgery cost include:
- Anesthesia fees
- Hospital facility fees
- Surgeon’s fees
- Pre-Operative lab fees
- X-ray fees
- Recovery time / Post-operative care.
There are also some things which may not be included in the cost of your gastric bypass procedure but that you should consider. For example, you may need post-surgery exercise or diet counseling, or behavior counseling, or vitamins and supplements. You may also require additional body contouring surgeries to remove excess skin, to lift sagging body areas or to improve relaxed muscles after your gastric bypass surgery. These procedures are not included in the initial cost of your gastric bypass procedure, so you should make sure to budget for them as well.
You should also consider that there are many factors that affect the typical cost of your gastric bypass surgery, including but not limited to the following:
- Geography: The cost of your gastric bypass surgery will be higher in an urban area, such as in Los Angeles or Boston precisely because in these areas surgeons tend to be in higher demand, and because overhead tends to be higher as well, just because the area is more densely populated. Make sure that you consider the geography of the area where you are finding your gastric bypass surgery.
- Your health insurance plan: If the gastric bypass procedure is a medically necessary procedure, there is a chance that some or all of your medical expenses will be covered. Make sure that you choose a surgeon and hospital that are in-network for the most significant cost savings.
- Your stay: If you end up needing to stay in the hospital longer to recover after your surgery, this could add to the cost of your procedure.
There is a lot that goes into the Pre-Op process. Your doctor will have you go on a strict Pre-Op diet in preparation for the surgery, and if you’re a smoker, you’ll have to quit. Behavioral therapy and nutritional therapy will help prepare you for your new life after the surgery because the gastric bypass will reduce your stomach to the size of roughly an egg and will reroute your intestines to drastically alter how you eat and enjoy the food. You must take the Pre-Op procedures seriously.
Your physician will tell you not to eat or drink anything after midnight the day before your surgery. There will be other pre-operative instructions for the day of your surgery. You may feel apprehensive, but this is entirely normal. Make sure that you take your regular medications unless there are any your surgeon told you not to take. You should arrive in comfortable clothing, but avoid wearing contact lenses, jewelry or any makeup the day of your medical appointment. Your surgeon will meet with you and do a routine examination to make sure you are healthy and ready for your surgery.
The surgery itself takes approximately two to four hours to complete and is done under general anesthesia. The surgeon will cut and staple the stomach to create a small pouch at the end of the esophagus, and this new stomach will only hold approximately 28 grams of food. The remainder of the stomach will remain attached to the top of the small intestines but will no longer be functional. The surgeon will then re-route the intestines so that food moves more quickly to the lower intestine, allowing food to pass more rapidly through the body, allowing for malabsorption, which aids in quicker and more efficient weight loss.
After the surgery, you can expect to be in the hospital for two to three days recovering. If there are any complications, you may be asked to stay longer. You should expect to take between one and three weeks off from work to recover, and full recovery will take between four and six weeks.
Which Insurers Cover Gastric Bypass Surgery
It is important to make sure that your healthcare provider is going to cover your bariatric surgery before you begin the process to weight loss so that there are no surprises along the way. Even if you see your insurer here, you should make sure to call your insurance representative or to check your documentation to make sure that you are personally covered before you book your surgery, because this information can change. Some insurers have particular requirements for who does and does not qualify for bariatric surgery, and you will want to make sure that you meet all the requirements before you start your journey.
||BCBS Kansas City
|Blue Cross of CA
||Blue Cross Maryland Care First
|Blue Cross Blue Shield Of Michigan
||Blue Cross Minnesota
||Blue Cross Nebraska
||Horizon Blue Cross of New Jersey
|Blue Cross New York Excellus
||Blue Cross North Carolina
||City of LaCrosse, SEIU, ATU and Retirees
||Coventry Health Care
||Great West Healthcare
|Humana HCA Employees
Keep in mind that this list is by no means exhaustive. If you don’t see your insurer on this list, but they should be here, let us know.
Requirements Typically Required for Insurance
When you find that your insurance provider does cover your chosen weight loss surgery, the next step will be to determine what requirements they will have for you to have the surgery covered. Although each insurance provider’s qualification requirements are a little different, there are a few necessary requirements that you can almost always count on:
- Body Mass Index (BMI) exceeding 40, OR
- Body Mass Index is exceeding 35 with at least one comorbidity, such as sleep apnea, coronary heart disease, hypertension, type 2 diabetes or similar.
- Letter from your primary care physician noting the medical necessity of the bariatric surgery.
- Documentation of your non-surgical weight loss methods spanning at least six months. Some insurance providers will require that these non-surgical weight loss methods be medically supervised by your physician.
- That you are 18 years or older. For patients under the age of 18, there may be special considerations.
- That you consult the expertise of a weight loss surgeon before applying for assistance through your insurance provider.
- Undergoing a psychological evaluation.
- Undergoing a nutritional evaluation.
Different insurance providers will have different requirements depending on your individual situation. Contact your insurance provider to find out what their specific requirements are early so that you can get the ball rolling, especially if you need to begin documenting your weight loss efforts.
Does Medicare, Medicaid Cover Gastric Bypass?
Provided that you meet the coverage requirements, both Medicare and Medicaid do presently cover gastric bypass surgery. To qualify, you must have a BMI of at least 35 and at least one co-morbidity, such as high blood pressure, diabetes, or sleep apnea. You must also have documented evidence that you have been obese for at least five years. Both Medicare and Medicaid have additional requirements as well, such as documentation from your primary physician showing that you have tried other medically supervised weight loss programs for at least six months, passing a psychological exam, and proof showing that your weight loss surgery is medically necessary.
Gastric Bypass Cost Without Insurance, Self-Pay Options
If you find that your insurance provider will not cover your gastric bypass surgery, there are a couple of options for you to consider in the realm of self-pay. Some of the options that you will want to consider include loans and payment plans if you don’t already have the money in savings available to you.
Loans: Loans are one option that patients can turn to when they’ve been denied insurance coverage for a gastric bypass. Make sure that you talk with your physician to determine exactly what your surgery is going to cost so that you are borrowing enough to cover everything. You will want to budget for all of your expenses and have some left over in case there are complications, such as additional recovery time needed. Keep in mind that you will also need to pay interest payments along the way.
Payment Plans: Many hospitals and bariatric surgery centers also offer payment plans that will allow you to pay off your surgery costs over time, rather than paying the full amount off all at once. The cost of surgery for such an option is sometimes less than for patients who pay in full through their insurance, so make sure that you speak to your physician about this option if you are having difficulty getting coverage through your insurance provider to find out what your options are.
Gastric Bypass Surgery Abroad: Medical Tourism
Another option that is available to you is to have your gastric bypass surgery abroad. Medical tourism is an option for people who want to pay less for their surgery because in some countries you can pay significantly less for your operation while permanently “vacationing” on your recovery. One of the most popular destinations for gastric bypass is Mexico, where you can have your entire surgery and recovery process for as little as $7,000 to $10,000. If you are paying out of pocket, this is a consideration that you may want to make.
Related: Weight Loss Surgery in Mexico – Self-Pay Guide
Gastric Bypass Financing Options
Whether you have insurance coverage or not, are paying entirely out of pocket or are getting some help from your insurance provider, it will be wise for you to consider your financing options sooner rather than later. It may be a good idea to have a strategy that combines a payment plan with insurance coverage, for example, and don’t forget about the lucrative tax deductions that come with medical expenses, mentioned below.
Tax Deductions of Gastric Bypass Surgery
Because obesity has been ruled a serious medical condition, medical expenses that exceed a certain percentage of your adjusted gross income can be deducted at tax time. Deductible medical expenses can include bariatric surgery, including gastric bypass surgery, approved weight loss plans and nutritional counseling, as long as these programs were approved by your physician and the expenses exceed 7.5 percent of your adjusted gross income. Additionally, you must itemize your deductions the year you claim them to qualify. It is always a good idea to talk to your tax professional before taking such a deduction.
- Costs of Gastric Bypass Surgery
- Life and Recovery of Gastric Bypass Surgery
- Pre-Operative Gastric Bypass Diet
- Post-Operative Gastric Bypass Diet