If you’re struggling with obesity and considering bariatric (weight-loss) surgery, you might be concerned with how much it costs.
While we at ClearHealthCosts can’t don’t give medical advice on things like whether or not you should get it, we did create this patient-centered guide for paying for bariatric surgery.
What is bariatric surgery?
Bariatric surgery – sometimes called weight-loss surgery – refers to a set of operations on the gastric organs to help a patient with weight loss.
Bariatric surgery helps people lose weight by effectively shrinking the size of the stomach, limiting how much food they can eat. While it is expensive, the doctors who support it say it is worth the cost because it saves lives and money in the long run.
There are three basic types of bariatric surgery, but the general principles for how much it will cost you are the same.
Gastric band, also called laparoscopic band, is the least major option.
Gastric sleeve is the most common bariatric surgery. In this procedure, the surgeon removes a part of the stomach so all that remains is a small portion.
There are more than one different types of gastric bypass surgery but they all involve sealing off part of your stomach with surgical staples, creating two smaller sections. The surgeon then reroutes the intestine so it only connects to one section. The stomach that is left behind is smaller and it connects to the digestive system.
In terms of pricing out your surgery, there are three main things to consider: what type of procedure you have, what kind of insurance you have and the preoperative and postoperative care you’ll need.
Obesity
“Bariatric surgery is, at this time, the most effective treatment that we have for obesity,” Dr. Annie Ehlers, a surgeon, researcher and assistant professor at the University of Michigan said in a phone interview.
Doctors and other experts say obesity is a public health crisis in the U.S., with more than one in three adults and one in five kids struggling with the condition.
But obesity is notoriously difficult to treat. Ehlers said there is a common myth that losing weight is just a matter of willpower.
“Many patients are not able to lose a significant amount of weight with diet and exercise,” she said.
Obesity can be dangerous. People with obesity have an increased risk of complications including diabetes, heart disease, certain cancers and early death.
Studies suggest that weight loss in general and bariatric surgery in particular can help prevent the onset of some conditions and help get them into remission in people who already have them.
“Bariatric surgery is an intervention that can not only help patients lose weight, but it can cure diabetes, high blood pressure, high cholesterol, sleep apnea and can add years of life for patients,” she said.
But not all patients can afford the treatment.
The American Society for Metabolic and Bariatric Surgery issued us a statement saying that, while most insurers cover bariatric surgery at least in part, high out-of-pocket costs and other barriers limit coverage, meaning that only an estimated “1% of eligible patients receive metabolic/bariatric surgery in any given year.”
Weight loss surgery and insurance
In 2019, more than 250,000 weight loss surgeries were performed in the United States, the A.S.M.B.S. said. Both the A.S.M.B.S. and the International Federation for the Surgery of Obesity and Metabolic Disorders recommend the treatment for most adults with a body mass index of 35 or higher or – if the patient also has a concurrent associated condition like the ones we mentioned above – a B.M.I. of 30 or more.
In January, the American Academy of Pediatrics issued new guidance recommending that bariatric surgery be considered for children and adolescents with obesity.
While we couldn’t nail down an exact figure, the clinicians and patients ClearHealthCosts spoke to said that most health insurance plans, including Medicaid and Medicare, cover bariatric surgery for patients that meet certain requirements, including a high enough B.M.I. and/or comorbidities.
One woman’s story
After many years of considering bariatric surgery, Michelle Price, a voice actor in Virginia, was finally ready to get it. Her doctors agreed she was a good candidate for a gastric sleeve; she had obesity, was diagnosed with sleep apnea and was prediabetic.
It was a major surgery that could save her life. But in the back of her mind, she was worried about one thing: the cost.
“You had to give them a form at that info session if you were interested with your insurance information, and I was terrified that it wouldn’t be covered,” Price, 37, said in a phone interview.
In preparation, she had already found a local surgeon she trusted, and a patient support group she loved when she heard from her insurance company.
“They called me and they told me it’s not covered.”
They gave no reason why. She felt devastated.
“I called my mom crying,” she said. “What am I going to do now? I can’t afford all of this.”
ClearHealthCosts reached out to HPI, the company that administers Michelle’s health insurance, for a comment. We have not heard back.
So what does bariatric surgery cost?
Michelle could not remember the exact price the operation would cost, but she knew it made the operation impossible.
“I think the total was going to be something obscene. Like 40 or 45 grand or something,” she said.
Note: At ClearHealthCosts, we have learned that prices quoted to patients can vary widely for the same procedure. Another patient we interviewed was given a very different price for a gastric sleeve.
“The surgery is not even expensive. It’s 10 to $15,000,” he said in a phone interview. “If you got enough money, you literally just pay it out of pocket, if you have that kind of cash.”
In particular, it is common for people to hear an estimate that is very high — something like a sticker price or M.S.R.P or rack rate at a hotel. In most cases, an insurance company or a cash customer ends up actually paying much less. ClearHealthCosts has noted several times how a patient might get a better price by putting away her insurance card and paying cash — or paying cash after an insurance company has denied a treatment.
The crowdfunding site GoFundMe currently has many fundraisers in progress for people paying cash for all types of bariatric surgery. From our research, it looks like many patients are expecting to pay between $8,000 and $15,000 — sometimes depending on which type of procedure – but we also saw some who were looking for $30,000 or more.
Many people wrote they found out their insurance would not cover their surgery — in full or in part — only after they were already seeking a nutritionist and beginning to lose weight in preparation for the operation.
Another option: Medicaid
It looked like Michelle would not be able to have the surgery, but soon, she realized she had another option.
“I had completely forgotten,” she said. “When we moved to Virginia about a year and a half ago I applied for insurance through the [Affordable Care Act’s online] marketplace.”
It turned out Michelle had qualified for Medicaid and enrolled in a health plan that had not expired yet. And that plan did cover bariatric surgery.
“I called [the doctor’s office] right back, and I said, actually, I have this insurance. I forgot that I even had, can you run this?” she said. “And she ran it. And she called me back like 10 minutes later. And she’s like, you’re 100% covered.”
Michelle is hoping to schedule her gastric sleeve surgery this summer.
While Medicaid and Medicare often cover bariatric surgery, there are a lot of people who cannot get coverage — perhaps because their insurance denied them, or they are uninsured. The A.S.M.B.S. gave us a statement saying that metabolic and bariatric surgery is covered at least in part by many insurers.
Other expenses: Prerequisite care
When insurance covers surgery, they also generally pay for the extensive prerequisite care you are required to get. Doctors and insurance companies mandate these extra steps to help patients prepare for the drastic changes to their bodies that come after the operation.
“When the surgery is finished, your stomach is only going to be an ounce whether you get gastric bypass, or if you get sleeved,” Michelle said. “if you [eat or drink] too much too quickly, you’re going to just throw up.”
Most preoperative programs include seeing a nutritionist or dietician, getting a psychological evaluation and sometimes losing 5% to 10% of your body weight as preparation.
The purpose of this is two-fold: to make sure you are healthy enough to handle the surgery and also to ensure the surgery will be successful – that you’ll keep the weight off, long term.
“I just had [my third] dietitian appointment, and she said I think that we’re going to need to see you at least a fifth time,” Michelle said. “They really want to monitor your habits and make sure you’re keeping up with them.”
Michelle also had to meet with a mental health clinician twice – another common requirement for bariatric patients.
Psychiatrist or therapist evaluations
Louisa Latela, a clinical social worker in New Jersey, has routinely done evaluations for bariatric surgery candidates for over 15 years. She said that insurance companies do pay for patient visits as long as the counselor is in network.
The main purpose of seeing a psychiatrist or therapist, Latela said, is to make sure the patient knows what they are getting into.
“We want to make sure they understand this is not a quick fix,” she said. “This is a tool, it’s not a cure.”
Latela said that, because obesity is a chronic health condition, patients must be able to make long-term lifestyle changes after the surgery, or they risk gaining their weight back. Also, if a psychiatric or other mental health condition is one of the contributing factors to obesity, it’s important to address it so the patient can keep off the weight they lose.
“Some people have real food addictions,” she said. If these patients don’t get treatment, Latela said they also often regain the weight they have lost.
Paying for postoperative care
Another potential postoperative expense is skin removal surgery – something that may be necessary.
“Typically, within the first one and a half to two years is when patients have the maximum weight loss,” Dr. Dustin Cummings, a bariatric surgeon in New York City. “Depending on how dramatic that weight loss is, patients may have a lot of excess skin to deal with.”
Not all bariatric patients need skin removal surgery, but for some, the extra skin may become painful and leave patients vulnerable to infection.
“We have plastic surgeons evaluate them because every patient is a little bit different in terms of their needs,” he said.
While skin removal surgery is medically necessary for many patients, patients sometimes have to fight to get their insurance to pay for it.
“If patients are struggling with any kind of disability from [excess skin], be it chafing, issues with self care, intimacy, things of that sort, we make note of to make sure the insurance companies realize it’s a hindrance, and they can get it taken care of,” he said.
Many people who need skin removal surgery launched fundraisers on GoFundMe looking for between $5,000 and $65,000 after their insurance plans said they would pay little or nothing toward the procedure.
Revisions
Some patients who don’t lose enough weight, regain too much or develop a rare complication like persistent acid reflux or hiatal hernia may require a second surgery, also called revision surgery.
There are several types of bariatric revisions, depending on which type of procedure you had initially and what issues you are experiencing now. But almost all types entail making your stomach – or gastric pouch – smaller again, back to the size it was after your first operation.
Oscar Gonzalez, a journalist in New York City, had a revision surgery – a gastric sleeve – in 2021. For his second operation, Gonzalez had to go through much of the pre-op leg work he did his first time around, including losing some weight in advance of the surgery.
“[I went] through the hoops of getting several doctors to basically say you should lose weight and then also going through six months of weight checks,” he said in a phone interview.
Gonzalez had his first bariatric surgery in 2008. His surgery was initially successful, but within 10 years, he had gained back most of the weight he had previously lost and qualified for bariatric surgery once again. That operation, called a lap band procedure, is almost never performed anymore because of its higher rate of failure than newer methods.
“They just take a band and wrap it around your stomach, and voila, you have a smaller stomach,” Gonzalez said. “But sometimes, the part that’s been wrapped up actually starts getting bigger.”
Gonzalez’s insurance – Medicaid – covered his revision surgery, but that is not always the case.
On GoFundMe, we saw fewer people raising money for revision surgeries. There were few examples of patients whose insurance denied their revision surgery, even in cases where it was determined to be medically necessary, although our research suggests this is relatively rare. We saw a range from $8,000 to $14,000.
Three things you can do
- Start researching and prepping early
Because your insurance company may need a patient to take multiple steps before approving bariatric surgery, it is not uncommon to have to wait six months to schedule the procedure. If you are considering bariatric surgery, remember your timeline may span months, not weeks.
- Medical tourism: Going abroad for a better price
People who want to pay cash for their bariatric surgery – either because they were uninsured or do not want to use their insurance – often consider having their operation done overseas, where medical costs are lower. This Mexico practice does initial procedure and revisions. Of course we are not recommending this practice – we do not make medical recommendations – but we did hear it’s not uncommon to consider surgery outside of the United States.
But patients we spoke to say there are some downsides to having your surgery far from home. Michelle Price told us her feelings.
“As much as you want the surgery, like now, if you don’t go through the program and follow what they’re telling you to do, then you’re not going to really succeed,” she said.
That is, if you get surgery in one place and your nutritionist, counselor and support group are somewhere else, it can be harder to coordinate and some things might fall through the cracks,
- Document everything so your medical team can help you get your associated treatment paid for.
Michelle Price said she doesn’t know if insurance would cover skin removal surgery for her and that she may have to push for it.
“The doctor basically said usually he can get them to cover it,” she said. “So I’ve been told, document, document, document, with photos and also like journals or telling your doctor. That way, when it does come time to have surgery, you’ve got plenty of evidence to say this is the problem this is causing me.”
