Obesity Surgery & Insurance - Weight Loss Surgery Cost in Los Angeles

The “Ins and Outs” of Insurance and Obesity Surgery & How to Afford a Weight Loss Procedure without Coverage

Doctors Performing Obesity Surgery

Concern over finances is one of the most common reasons people put off or deny themselves the benefits of obesity surgery.

Even after knowing how safe surgical procedures like gastric sleeve can be, which has an incredibly low complication risk (the risks of staying obese are much greater than any bariatric surgery)…

And even after seeing before and after photographs of people whose lives have been completely changed for the better…

And after reading stories of how weight loss surgery has helped so many people get what they want out of life, without obesity and co-existing medical conditions slowing them down…

Even after all that, the worry over how to pay for surgery is what holds many back from experiencing life-changing bariatrics, the ticket to a slimmer new you and a healthier and longer life.

So, let’s break it all down.

The fear of anything almost always arises from a lack of information.

The information that follows will help to put your anxieties to rest. It is done by keeping you informed of all that goes into the financing of bariatric surgery.

And it will help you realize that you can have surgery even if you don’t have tens of thousands of dollars lying around and you don’t carry health insurance!

Whether you have insurance or not, this post will help you understand how much surgery is likely to cost. It also shows you the various ways you can afford to pay for your procedure to permanently improve your life.

How Much Does Weight Loss Surgery Cost?

Bariatric surgery may be minimally invasive and will have you walking around and recuperating in just a couple of days. However, the surgery is still a serious surgical procedure and therefore is not exactly cheap.

The typical costs for obesity surgery can range from the low $10,000s to $25,000 or more.

Procedures like the gastric sleeve, for example, start at around $15,500 to $18,000 per surgery without insurance.

You may wonder why it costs so much. The price you can expect to pay could be more or less, depending on a few factors.

Medical Fees

Your fee will go toward the use of the medical facility, the surgeon, anesthesiologist, and your short recovery stay.

Your fees will also go toward the use of multiple devices, such as the laparoscope, which is a tiny camera that lets the surgeon perform the procedure inside your abdomen through tiny incisions, and the monitor that gives the surgeon a visual of the operation being performed.

Hospital You Chose

Every medical facility charges its own rates for the use of the facility and the expertise and readiness of the staff that will assist you. These fees will be included in the total amount you pay for your weight loss procedure.

Type of Surgery

Gastric sleeve, gastric balloon, and other bariatric procedures each come with their own associated costs and fees.

The only way to get a true estimate of the costs you can expect to pay is by speaking with a qualified and experienced weight loss surgeon like Dr. Moein of Healthy Life Bariatrics, who has helped dozens of individuals just like you achieve their weight loss goals.

Even with insurance, you may end up paying around $3,500 out of pocket, but it depends on the procedure and the specifics of your insurance policy.

You Know What’s Really Expensive? NOT Having Obesity Surgery

Obesity is not an adjective that describes a heavier person. It is a medical term that describes a serious health-related condition.

Being obese puts a major strain on society at large. This isn’t to make you feel bad if you are obese. It’s a growing problem we all share, since obesity affects at least a third of all adults.

The latest studies show the economic burden of excess weight to be well over $92K per person.

We calculated the figures by adding up all the direct medical costs and lost productivity over time. It includes taking too many absences from work. Also included are short-term disability payments, higher insurance premiums, and associated tax revenue.

Another study showed that nearly a quarter of all national health care costs are preventable expenses related to being overweight or obese.

In fact, the CDC found that obese people pay around to $2,700 more for healthcare compared to those of normal weight.

Overall, obesity costs the country $147 Billion in yearly medical expenses, with federal programs like Medicare and Medicaid sharing the biggest piece of the economic toll. However, it will also affect many individuals like you.

Choosing bariatric surgery, which offers a one-time expense, can significantly lower your future costs. You’ll not only enjoy more savings, but you’ll have more energy and vigor to use that money to get more out of life!

If You Have Health Insurance, Your Policy May Cover the Full Costs

All those premiums you paid or amounts you had deducted from your paycheck may pay off if your insurer covers bariatric surgery.

Imagine being whisked into the obesity surgery program right away, without having to worry about finances at all. That is the ideal situation, and some insurers will allow for that very “easy-going” weight loss journey.

Read your policy over carefully and call your insurer. You can also speak to your weight loss surgeon who is used to dealing with insurance companies.

You will be happy to know that Under the Affordable Care Act, some states require health insurance companies to sell plans that cover bariatric surgery.

According to the NCSL (National Conference of State Legislatures), most states have expanded health insurance coverage for the treatment of obesity. Some of the laws in place even target diabetes.

Twenty-three states now have specific health benefit requirements that cover weight loss surgery. Before the ACA, only five states offered coverage for the morbidly obese.

Sixteen states now offer coverage and reimbursement for nutritional counseling and therapy, including dietary and nutritional screening and weight loss programs. Seven other states offer nutritional counseling or therapy, but only for diabetes-related conditions.


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Does Your Insurer Cover Obesity Surgery?

ObesityCoverage was kind enough to put together a list of insurance companies and their requirements for obesity surgery coverage.

United Healthcare is the most popular carrier in the U.S.. It requires that you have a body mass index (BMI) greater than 40, which is classified by the insurer as Class III Obesity.

Those with class II Obesity (BMI greater than 35) can be covered if they also have one or more comorbidities, such as Type 2 diabetes, cardiovascular disease, or severe sleep apnea, or other life-threatening cardiopulmonary conditions.

Insurance policies in the state of Maryland have their own unique criteria. To be covered, patients must be 18 years of age or older. They also should have a BMI over 40 without comorbidities or a BMI of 35 or greater with comorbidities including hypertension, sleep apnea, cardiopulmonary conditions, diabetes, or any other life-threatening medical condition that is weight-induced.

Maryland patients must also show proof that they have tried diets. They also have to show exercise programs to lose weight for the long-term prior to considering surgery. Examples include showing the insurer proof that you once were a member of programs like Weight Watchers, Jenny Craig, or that you joined a gym and participated in nutritional counseling and personal training for a period of time, only to have minuscule results to show for your efforts.

Diet

Structured Diet Programs after Obesity Surgery

To qualify as proof of your efforts to lose weight, you must have participated in a structured diet program like Jenny Craig or Weight Watchers for 6 consecutive months, or two structured diet programs for three consecutive months.

United Healthcare covers most common obesity surgeries like the gastric sleeve (also known as laparoscopic sleeve gastrectomy), which is also approved for coverage for adolescents.

UH is only one example of an insurer that has strict requirements before they will cover weight loss surgery.

Check with your insurer to see if the procedure you want is covered.

How Do You Convince Your Insurer That Weight Loss is Necessary?

Most insurance companies require a letter of medical necessity.

This is a document from your bariatric surgeon and primary care physician that states:

  • Your height and weight history.
  • BMI (body mass index)
  • A description of your obesity-related health conditions. The document may also include records of treatment for those conditions.
  • A rundown of the limitations your obesity places on your lifestyle and daily activities.
  • Detailed history of your dieting efforts, including medically and non-medically supervised dietary programs.
  • History of exercise programs, including receipts for memberships to gyms and health clubs.

You might want to ask your doctor to include information from medical journals that state the effectiveness of weight loss surgery, particularly for the control or elimination of obesity-related health conditions.

Some carriers require a consultation with a nutritional expert along with a psychological evaluation. Your surgeon can help to put you into contact with the professionals needed to satisfy the claim’s requirements.

Comorbidity Can Increase Your Chances of Obesity Surgery Cost Coverage

Health conditions like type 2 diabetes

The insurance companies are aware that people who are  obese are also more likely to have associated health conditions. These conditions include type 2 diabetes, heart disease, high blood pressure, sleep apnea, and high cholesterol.

You are more likely to get insurance to pay for your procedure, even if your state does not mandate coverage, if you have a high BMI and associated conditions that threaten your life or make it hard to live.

What if Your Insurer Denies You Coverage?

Even with health insurance, you may have trouble convincing your insurer to cover the procedure.

According to the American Society for Metabolic & Bariatric Surgery, 25% of patients considering surgery were denied coverage three times before finally getting approved.

If you are denied coverage for any reason, be sure and appeal the decision. Speak with the HR person at your place of employment to ensure all your documents are in order.

Have your surgeon write an appeal letter addressing the denial and why it should be reversed.

If you are denied again, you often have the right to request a “second level appeal”. Or you can even have your case reviewed by an unaffiliated third party. Check with your insurer for details.

What if Your Employer’s Health Insurance Policy Doesn’t Cover Weight Loss Surgery?

Jennene Wheeler, RN, CBN, and coordinator for MultiCare.org’s bariatric program recently said that employers are increasingly recognizing the benefits of bariatric surgery for employees and for insurance policies that cover the procedures.

Wheeler suggests that, if your employer-provided insurance plan doesn’t cover surgery, you may need to do some lobbying with your organization’s human resources department or union representatives.

She adds that there have been cases where employers or insurers will cover the procedure on a case-by-case basis. But patients need to ask. After all, you don’t get what you don’t ask for.

Are You Screwed with No Insurance Coverage and if You Don’t Have $20K Lying Around?

No insurance coverage? No problem. If you don’t have health insurance, or you live in a state that does not include bariatric surgery on its list for essential health procedures, you will likely have to pay the bill in its entirety all on your own.

You have a few options when it comes to paying for surgery if you have no health insurance to speak of.

  • Consider a medical loan. Some bariatric surgery centers, like Healthy Life Bariatrics in sunny and beautiful Los Angeles, offer one or more financing options, like obesity surgery loans from Prosper Healthcare Lending.
  • Consider a Job with benefits. Now that you know the states that cover obesity surgery and the insurers that do, you can plan ahead starting today. Look for a job that offers benefits with the insurer in question. Or move to a state that covers surgery to change your life for the better.
  • Seek Medicare Coverage. Medicare will cover a portion of the costs of some bariatric surgeries. To qualify, you must have limited income and be both obese and suffer from obesity-related health conditions. You must also have the procedure done at a Medicare-approved facility.
  • Get a Reduced Self-Pay (Cash) Rate. Many weight loss surgery facilities, like Healthy Life Bariatrics, offer discounts if you pay with cash. Call the office at (310)881-8260 to learn more about our self-pay rate.

Loans for Obesity Surgery – Finally, Affordable Healthcare!

Make Obesity Surgery Affordable

Source

A premier financing company in the healthcare industry, Prosper Healthcare Lending, has helped over a quarter of a million people live-out their weight loss dreams with over $3 Billion borrowed overall.

With many of these loans, you get instant decisions. They include longer terms for lower monthly payments, and the loans are unsecured, so there is no collateral required.

The loans can not only be used to finance your weight loss surgery. However,  many patients use the funds borrowed to pay for their body contouring procedures after the weight has come off.

Doctors like Dr. Moein of HLB, who are experts in both bariatric surgery and cosmetic surgery, can help you achieve your weight loss and body shape goals.

You can drop the excess weight and remove any hanging skin afterward.

You can lose ten dress sizes before getting a mommy makeover. This will help you turn a new leaf and a bunch of heads everywhere you go.

If you are hesitant to take out a loan because you’re afraid that you won’t be able to pay it back, just think: The discipline you learn to live a healthier lifestyle through your weight loss journey will help you form the discipline to do anything else you want in life, including pay off any loans you take out to fund the process along the way.

Ask Your Weight Loss Surgeon About a Self-Pay Discount

Don't let finances hold you back

 

If insurance does not cover your weight loss surgery, that should never prevent you from living out your weight loss fantasies. Except here’s the thing: Losing all your excess weight does not have to be a fantasy!

Doctors like Dr. Moein of Healthy Life Bariatrics can help you figure out how to fund your obesity surgery for a ticket to a healthier you.

While you’re at it, ask about the HLB Fast Track to Weight Loss program, which includes a bonus where the more weight you lose, the more you save on one or more body contouring procedures after the weight has come off.

The bottom line is that bariatric surgery is an investment in your life. Having the procedure can help you make the lifestyle changes you need for the better.

You will save money in the long run as you age because your health will be improved. This will leads to lower medical costs and fewer prescription drugs required.

With the money you save on bariatric surgery – insurance or not – you’ll be able to live life on your terms while saying goodbye to obesity for good.

Call to speak to Dr. Moein and staff at Healthy Life Bariatrics to discuss how to finance your weight loss journey. Dr. Moein is now conducting virtual consultations. Call (310)-694-4486 to schedule a time that is best for you.

 

 

 

Dr. Babak Moeinolmolki August 1, 2020

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