Gastric Sleeve Costs and Insurance Guide

Understanding the costs of weight loss surgery is an important step to preparing to make the decision whether gastric sleeve is right for you. The overall cost of gastric sleeve surgery will depend on the location that the surgery is being administered, whether you have insurance, and have the bariatric coverage, and which surgeon you choose.

Gastric SleeveGastric sleeve surgery is a bariatric procedure that removes a portion of the stomach in order to promote weight loss in patients. Patient experience rapid weight loss and feel less hungry after their procedure. This is because the stomach is smaller and the portion of the stomach that produces the hunger hormone, Ghrelin, is removed during surgery. 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 surgery is lower somewhere doesn’t mean that that bariatric surgeon is any less skilled. The price is determined from 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.

According to Bariatric Surgery Source, the average cost of Gastric Sleeve surgery in Canada is $19,625 CAD (approximately $14,800 USD), $4,200 AUD in Australia ($3,139 USD), and 11,100 Euros in the United Kingdom ($11,928 USD).[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 just $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 Weight Wise Bariatric Program
$4,100 Mexico Florence Direct Care

Price information as of December 2016:

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. These 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 last 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 costs that may occur during surgery include radiologist fees and pathologist fees for reviewing biopsies if necessary.

Post-Op/After Surgery

Generally post-op or after surgery costs can vary from patient to patient. However, some of the most common costs 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 to always take time to research the costs associated with gastric sleeve surgery or any other surgery therefore. Ask questions that will make you decision easier to 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[7]

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 with 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 basic requirements associated with approval for weight loss surgery including 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 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 fully before applying for insurance coverage for your gastric sleeve surgery.

The review process generally 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 just gastric sleeve.[9]

In terms of Medicaid, obesity-related services that help to prevent and manage unhealthy weight are generally 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. Generally 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).

Certain 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 state 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 costs 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 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 claim 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 travelling back to your home state. Generally, air fare is not included in the cost. Although, the trend is growing

Tax Deductions of Gastric Sleeve Surgery

Thankfully in the United States, weight loss surgery is tax deductible if the costs 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 for 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 a great option for individuals who want to save money on their surgery 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.

References:

1. http://www.obesitycoverage.com/weight-loss-surgery-insurance-coverage-and-costs/
2. http://www.bariatric-surgery-source.com/gastric-sleeve-surgery.html#Cost-Main
3. https://www.mexicobariatriccenter.com/gastric-sleeve-surgery-costs/
4. http://obesityreporter.com/gastric-sleeve/gastric-sleeve-cost/
5. http://www.bariatric-surgery-source.com/gastric-sleeve-cost.html
6. https://www.marinahospital.com/faq/how-much-gastric-sleeve-costs
7. http://www.obesitycoverage.com/insurance-and-costs/am-i-covered/check-my-insurance
8. https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/Bariatric_Surgery.pdf
9. https://www.medicare.gov/coverage/bariatric-surgery.html
10. http://obesityreporter.com/does-medicaid-cover-weight-loss-surgery
11. https://www.mexicobariatriccenter.com/services-list/gastric-sleeve-surgery/
12. http://www.bariatric-surgery-source.com/gastric-sleeve-surgery.html#Cost-Main
[1] http://www.obesitycoverage.com/weight-loss-surgery-insurance-coverage-and-costs/
[2] http://www.bariatric-surgery-source.com/gastric-sleeve-surgery.html#Cost-Main
[3] https://www.mexicobariatriccenter.com/gastric-sleeve-surgery-costs/
[4] http://obesityreporter.com/gastric-sleeve/gastric-sleeve-cost/
[5] http://www.bariatric-surgery-source.com/gastric-sleeve-cost.html
[6] https://www.marinahospital.com/faq/how-much-gastric-sleeve-costs
[7] http://www.obesitycoverage.com/insurance-and-costs/am-i-covered/check-my-insurance
[8] https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/Bariatric_Surgery.pdf
[9] https://www.medicare.gov/coverage/bariatric-surgery.html
[10] http://obesityreporter.com/does-medicaid-cover-weight-loss-surgery/
[11] https://www.mexicobariatriccenter.com/services-list/gastric-sleeve-surgery/
[12] http://www.bariatric-surgery-source.com/gastric-sleeve-surgery.html#Cost-Main