Weight Loss Surgery Costs, Insurance Coverage & Financing Explained
Posted: March 14, 2023
The dedicated weight loss specialists at Alabama Surgical Associates understand that cost is a significant factor for patients considering bariatric surgery. The cost of the procedure, as well as the cost of pre-and post-operative care, can add up quickly. Additionally, many insurance plans do not cover the full cost of weight loss surgery, so patients may be responsible for paying a significant portion of the cost out of pocket. This can be a deterrent for some patients who may not be able to afford the procedure.
How Much Does Weight Loss Surgery Cost?
The national average cost of weight loss surgery can vary depending on a number of factors, such as the type of procedure, the location of the surgery, and the patient’s individual insurance coverage. However, generally speaking, the national average cost for weight loss surgery can range from $7,400 to $33,000.1
It’s important to note that weight loss surgery is not always covered by insurance and if it is, the coverage and cost may vary depending on the provider.
At Alabama Surgical Associates, we strive to make weight loss surgery attainable for everyone—regardless of insurance coverage. Our Self-Pay pricing starts as low as $119 per month and are among the lowest prices in the nation.
The ASA Self-Pay Difference
In contrast, with rates starting at just $119 per month, our self-pay costs for bariatric surgery at Alabama Surgical Associates are among the lowest rates in the nation because we believe that life-saving weight loss surgery should be attainable for everyone.
Weight loss surgery that is self-pay can be less expensive than surgery that is covered by insurance because self-pay patients are not subject to the same reimbursement rates and administrative costs that are associated with insurance coverage.
In addition, self-pay patients may not have to deal with the additional costs and restrictions imposed by insurance companies, such as copays, deductibles, or specific coverage criteria. It’s important to note that self-pay patients will pay the full cost of surgery, so the amount can be significant.
Understanding Insurance Coverage For Weight Loss Surgery
Insurance coverage for weight loss surgery, also known as bariatric surgery, can vary depending on the insurance company, your specific coverage plan, and your individual health history. Some of the factors that are involved in determining whether or not insurance may cover the costs of bariatric surgery include:
- Medical necessity: Insurance companies typically require that a patient meet certain criteria to be considered a candidate for bariatric surgery. These criteria may include having a Body Mass Index (BMI) of 40 or higher, or a BMI of 35 or higher with one or more obesity-related health conditions such as type 2 diabetes, sleep apnea, or heart disease.
- Type of procedure: Some insurance plans may cover certain types of bariatric surgery but not others. For example, insurance may cover gastric bypass surgery and laparoscopic sleeve gastrectomy, but not endoscopic sleeve gastrectomy.
- Documented weight loss attempts: Insurance companies may require patients to document that they have tried and failed to lose weight through non-surgical means, such as diet and exercise, before they will approve coverage for bariatric surgery.
- Provider network: Insurance companies may require patients to use a provider within their network or be subject to higher out-of-network costs.
- Pre-Authorization: Insurance companies may require pre-authorization before they will approve coverage for bariatric surgery. This process can involve the patient providing medical records and meeting with a medical review board.
Use our Free Insurance Check tool to check with your insurance provider about their specific coverage for bariatric surgery.
What Is NOT Covered By Insurance?
There may be certain aspects of weight loss surgery that are not covered by insurance. These can include:
- Non-medically necessary procedures: Some insurance companies may not cover certain procedures that are considered to be purely cosmetic in nature, rather than medically necessary.
- Revision surgery: Insurance companies may not cover the cost of revision surgery, which is surgery to correct or fix complications or problems that arise after the initial weight loss surgery.
- Follow-up care: Some insurance plans may not cover the cost of follow-up care, such as nutritional counseling, physical therapy, and psychological counseling.
- Experimental or investigational procedures: Insurance companies may not cover experimental or investigational procedures that are not yet widely accepted by the medical community.
- Out-of-network providers: Insurance companies may not cover the full cost of care when a patient uses a provider who is not in their network.
It’s important to check with your insurance provider to see what aspects of weight loss surgery are covered under your specific plan. You can use our Free Insurance Check tool to get started.
What Are My Options If I Don’t Have Insurance Coverage for Weight Loss Surgery?
If you do not have insurance coverage for weight loss surgery, there are several options that you can consider:
- Self-pay: As discussed earlier, our self-pay options may offer lower costs than insurance-covered options.
- Financing: We partner with Prosper Healthcare lending to provide a financing option available to patients who do not have insurance coverage for weight loss surgery. These can include personal loans, medical credit cards, and financing through the surgeon or facility.
- HSA & HRA: We accept Health Reimbursement Arrangements (HRA) and Health Savings Accounts (HSA) as payment options for weight loss surgery. If your employer offers either of these benefits, you can use pre-tax funds to cover the cost of the procedure. Additionally, it’s worth noting that using personal funds for weight loss surgery may also be tax-deductible.
- Alternative options: Patients can also look for alternative options, such as non-surgical weight loss treatments, which can be less expensive than traditional weight loss surgery and may be covered by insurance.
It’s important to note that the best option may vary depending on your circumstances and priorities. It’s important to consult with a weight loss specialist like Dr. Doucette, as well as your insurance provider, to understand all the options available to you and make an informed decision.
Pros & Cons Of Insurance Versus Self-Pay For Weight Loss Surgery
When it comes to weight loss surgery, there are pros and cons to both insurance coverage and self-pay options.
|Lower out-of-pocket costs||Higher out-of-pocket costs|
|6-month waiting period||No waiting period required|
|Surgeon must be in network||Patients can choose preferred surgeon|
|Follow-up care provided||Follow-up care is provided*|
|Patients must meet strict eligibility criteria||No eligibility criteria, surgery can be performed at physician’s discretion|
* Follow-up care is provided at Alabama Surgical Associates; this may not be true for other bariatric practices offering the self-pay option
It’s important to weigh the pros and cons and consider all of your options, including financing options, before making a decision. During your consultation at Alabama Surgical Associates, we’ll make sure you understand all of your options and are able to make the best decision for your situation.
The Cost Of Obesity
The cost of obesity can be significant and can include both direct and indirect costs.
Direct costs of obesity include:
- Medical costs associated with treating obesity-related conditions such as diabetes, heart disease, and high blood pressure2
- The cost of weight loss surgery and related care
- The cost of medications and supplements used to manage obesity and related conditions
Indirect costs of obesity include:
- Lost productivity due to time off work for medical appointments and treatment3
- Reduced earning potential due to limitations caused by obesity4
- Higher healthcare insurance costs for employers and employees5
According to studies, the economic cost of obesity in the United States alone is estimated to be in the billions of dollars annually. The cost of obesity can also vary by country and region and may depend on the healthcare system and other factors.
It’s important to note that the cost of obesity not only affects the individuals and their families financially but also psychologically and emotionally.6 Addressing obesity can help to reduce healthcare costs and improve overall health outcomes for individuals and quality of life.7
Start Your Weight Loss Journey Today
Weight loss surgery is one of many steps in the life-long journey to healthier living. At Alabama Surgical Associates, we’re here to provide you with insights, support, and the highest standard of quality bariatric care every step of the way. Contact us today to learn more about our bariatric program and the cost of weight loss surgery.
1 Obesity Surgery. What Are the Real Procedural Costs of Bariatric Surgery? A Systematic Literature Review of Published Cost Analyses. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5509820/. Accessed January 13, 2023.
2 STOP Obesity Alliance. Understanding The Costs of Obesity and Bariatric Surgery. Available: https://stop.publichealth.gwu.edu/fast-facts/costs-of-obesity. Accessed January 13, 2023.
3 BMJ Open. Obesity and sickness absence: results from a longitudinal nationally representative sample from Germany. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6009453/. Accessed January 13, 2023.
4 OAC. Weight Bias: Does it Affect Men and Women Differently? Available: https://www.obesityaction.org/resources/weight-bias-does-it-affect-men-and-women-differently/. Accessed January 13, 2023.
5 USDA. Health Insurance, Obesity, and Its Economic Costs. Available: https://www.ers.usda.gov/webdocs/publications/43439/15882_efan04004g_1_.pdf?v=0. Accessed January 13, 2023.
6 Endocrinology & Metabolism Clinics of North America. The Psychosocial Burden of Obesity. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6052856/. Accessed January 13, 2023.
7 Child Development. The Social and Emotional Lives of Overweight, Obese, and Severely Obese Children. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473502/. Accessed January 13, 2023.