Gastric Sleeve Insurance and How to Afford Surgery Without Coverage

Gastric Sleeve Insurance

The American population is suffering from an obesity epidemic. One out of every six Americans is classified as clinically obese. Hence, gastric sleeve surgery is the foremost solution for patients. Many of these individuals are also burdened by one or more related disorders. It contributes to a diminished quality of life and a potentially shorter one.

These disorders are referred to as obesity comorbidities, of which there are more than sixty. Most are currently on the rise, including type 2 diabetes, high blood pressure, obstructive sleep apnea, and weight-related cancers (particularly in young adults).

Surgeries like the gastric sleeve (laparoscopic sleeve gastrectomy) are the best defense against obesity and the illnesses accompanying morbid obesity.

Gastric sleeve surgery can give you a healthier and potentially longer life, but the procedure’s expense is not to be taken lightly.

The good news is that health insurance companies are starting to recognize the life-extending nature of bariatric procedures such as the gastric sleeve. Insurance can cover up to 80% of the costs in some cases, making the expense of bariatric surgery easier to manage.

But what if you don’t have insurance? Are you willing to pay out of pocket for the cost of gastric sleeve surgery? If so, how much would that be?

These are all excellent questions. Keep reading to find the answers below.

How Much Does Gastric Sleeve Cost Without Insurance?

A roll of money with a red ribbon tied around it.

Depending on your location, gastric sleeve surgery costs between $15,000 and $25,000. The gastric sleeve tends to be on the lower end of the scale, while bariatric procedures like the gastric bypass tend to be on the higher end of the price scale.

The average national cost of the gastric sleeve procedure is $15,400, according to Obesity Coverage.

The high cost of bariatric surgery is due to the need for an experienced surgeon and the high-tech tools necessary to conduct the procedure. Additional costs include dieticians, psychology visits, anesthesia, the surgical center, and other related fees.

Putting the Cost of Gastric Sleeve Surgery into Perspective

The costs associated with gastric sleeve surgery may seem overwhelming, but it may cost you more to remain obese when you compare the two options.

Health Care Spending

According to studies by major worldwide health organizations, you are being overweight or obese costs over $3,000 more annually in annual healthcare spending. Compared to someone of normal weight, as someone who is overweight or obese, you may have added costs related to treatment for obesity comorbidities like type 2 diabetes, cardiovascular disease, cancer, and other serious health problems.

Lower Salary

People who are overweight or obese tend to earn less than their normal-weight coworkers and have a more difficult time finding work in general. They are also more often passed up for promotions.

Missing Wages

When you are overweight or obese, you might take more sick days than your normal-weight peers. Taking time away from work can be costly. But then you have to factor in the productivity losses and the short-term disability and direct medical costs shared by employers and employees.

Expensive Clothing

Having to buy larger-sized clothing can be expensive. Manufacturers charge more for big tal,l, and plus-sized varieties.

These are just a few examples of how being overweight or obese can cost you. When you add them up over a lifetime, you’ll see that having gastric sleeve surgery is a bargain by comparison.

What Expenses Can Be Covered by Gastric Sleeve Insurance?

The cost of your procedure can be reduced drastically by choosing the best gastric sleeve insurance coverage.

Most major insurance providers now offer coverage for weight loss surgery. If you have bariatric surgery insurance coverage under your current policy, your costs will be reduced to the out-of-pocket expenses detailed by your health care plan.

How to Get Insurance to Cover Your Gastric Sleeve Procedure

A clipboard with a pen and a laptop on it.

Gastric sleeve qualifications for insurance coverage typically say you must be:

  • Over the age of eighteen.
  • Have a body mass index (BMI) greater than 40 (or 35 with one or more obesity comorbidities).
  • Officially diagnosed with morbid obesity.
  • A non-smoker or committed to quitting before the surgery.
  • Psychologically healthy and may be required to pass a psych evaluation to ensure mental fitness before surgery.
  • Willing to complete a weight loss plan as mandated by your insurance provider before or after your procedure.
  • Able to provide your insurance company with a well-documented history of your weight loss efforts.

Letter of Medical Necessity

For insurance to pick up some or all of your gastric sleeve charges, you must get a medical professional to vouch for you that medical intervention is necessary.

You would need to visit your general practitioner, a specialist, or a bariatric surgeon to get medically diagnosed. Then, the doctor would send the insurance company a letter of medical necessity.

Let’s examine those steps in greater detail.

Participate in a Diet Program

Insurance companies want to know that you’ve done everything humanly possible to try and lose weight before turning to surgery as life-changing as the gastric sleeve. One of the ways insurers can guarantee patients have thrown everything, including the kitchen sink, at weight loss is to enroll them in a doctor-supervised diet program.

Most insurance companies require a six-month weight loss program before approving surgeries such as the gastric sleeve. Medicare is the exception. While Medicare doesn’t require a program for any time, you might be encouraged to participate.

Psychological Evaluation

You need to understand the impact bariatric surgery can have on your lifestyle. A psychological evaluation ensures untreated psychological issues like binge eating are addressed before you can be scheduled for a weight loss procedure.

Nutritional Evaluation

A nutritionist will outline dietary changes and habits that you should change to succeed with long-term weight loss. Instead of looking at food in terms of taste and how well it fills you up, you’ll come to see foods for the much-needed fuel and essential health benefits they provide.

After you have completed this process, your bariatric surgeon sends the letter of medical necessity that preauthorizes you for weight loss surgery.

The letter consists of your medical history and related health problems. It will also include documentation that you have completed the necessary steps for approval.

Your insurance company goes through a review process, after which you are approved or denied.

If you are approved, congratulations. Your financial burden can be lessened at least somewhat.

But what if you are denied? What comes next?

What if You Are Denied Bariatric Surgery Coverage?

A doctor's hand writing on a clipboard with a heart and stethoscope.
A doctor’s hand writing on a clipboard with a heart and stethoscope.

If you are denied coverage for bariatric surgery, you are allowed at least one appeal. Use your right and send off a letter immediately.

Explain why they should cover the procedure under your health care policy.

You should also request a fully detailed reason for denying coverage. This process can also work if you feel the level of coverage is inadequate.

Please request a copy of the policy statement from their benefits book explaining why your coverage was limited or denied.

When you send the letter, include a copy of the denial notice and a copy of your doctor’s letter of medical intent in the same envelope.

All of these elements will help to build your case.

If You Get Your Insurance Through Your Job

If your work-provided insurance coverage does not include bariatric surgery, this might be an opportunity for you to enact change.

Call HR and ask why there’s no coverage for bariatric surgery. Prepare ahead of time to gather evidence showing the health benefits of surgeries like the gastric sleeve. Having surgery can change your life for the better and make you more productive at work.

While results are not guaranteed, don’t worry; you should not lose all hope if you lose coverage for your procedure.

Believe it or not, people have bariatric surgery without insurance and are not all swimming in pools of gold coins.

How to Afford the Cost of Gastric Sleeve Surgery Without Insurance

Millions of Americans suffer from obesity but lack insurance coverage for surgical intervention.

You can pay for surgery without insurance. It requires planning on your part and being meticulous with your record keeping.

Bariatric surgery can save your life. Even if you don’t have insurance or your health care insurer did not approve you for coverage, you can undergo a life-saving procedure such as weight loss surgery without insurance. Here are some options you can explore.

Get a breakdown of all the costs associated with bariatric surgery.

The cost of bariatric surgery is broken down into quite a few categories. You could fill up an entire page with all the fees you must pay as a weight loss surgery patient. The list would contain the surgeon’s fees, dietician’s fees, psychologist’s fees, surgical center fees, anesthesia costs, prescription medications, and medical tests.

Seeing the individual charges can help you identify ways to save money in the long run.

Ask for discounts and rebates for gastric sleeve patients.

Call the various providers, such as anesthesiologists, to determine if rebates are offered to uninsured gastric sleeve patients. Go down the list. You never know when you can shave hundreds or thousands of dollars off your final tally.

The Cost of Gastric Sleeve Surgery without Health Insurance

Gastric sleeve surgery without health insurance can cost as much as $20,000, all charges considered.

How to Pay for Gastric Sleeve Surgery Without Insurance

Medical Financing

A stethoscope sits on top of a stack of money.

The gastric sleeve cost is akin to buying a small to a mid-sized automobile. Most don’t pay for their cars, trucks, and SUVs with cash on hand. The ones who can’t shell out the full sticker price turn to financing. You can do the same when paying for bariatric surgery.

Companies such as CareCredit allow you to pay for gastric sleeve surgery, doctor visits, medical tests, follow-up care, and other in-network expenses related to your surgery.

CareCredit works like a credit card. If you have other credit cards, those can help you pay for any expenses not covered by your medical financing agreement.

Bank Loans

A personal or medical loan from your bank is an option to explore. Check with your bank to see if a loan can help cover some or all of the costs of your upcoming procedure.

Get Creative

Crowdfunding sites like GoFundMe are also excellent sources of funds that can help you in your weight loss procedure.

Don’t Wait to Have Bariatric Surgery

By now, we have discussed the cost of gastric surgery thoroughly, but the benefits of bariatric procedures go beyond dollars and cents.

Undergoing weight loss surgery can improve your health and your quality of life and give you a potentially longer life to boot.

It would be best if you never let a thing like money keep you from living your best, healthiest, and longest life.

Explore options with your bariatric surgeon. A single consultation will help.

If you live in the Los Angeles area, schedule a consultation with Dr. Babak Moeinolmolki. Gastric sleeve is one of the most popular weight-loss surgeries in the United States. You’ll be in good company as you consider changing your life for the better with this revolutionary weight loss surgery. You can learn more about gastric sleeve insurance coverage, paying for surgery without insurance, and the risks involved by dialing 310-861-7844.

Dr. Babak Moeinolmolki
March 28, 2022
Dr. Babak Moeinolmolki
Scroll to Top