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Insurance If you’ve got health insurance, start by contacting them to see if A) they cover the cost of gastric sleeve surgery and B) what their specific requirements are. Insurance is by far the most affordable way to have your gastric sleeve cost covered.
Every insurance company is different, so there will be variables, but in general, they require some or all the following:
Age 18 or older A BMI of 40 or higher or a BMI of 35+ with comorbidities. Comorbidities normally include diabetes, high blood pressure, sleep apnea, and joint problems. (This list is not all-inclusive; your insurance company will have a complete list) 3-6 months in a medically managed nutrition or weight loss program. *may or may not require a certain amount of weight loss pre-op Testing that includes a psychiatric evaluation clearing you for surgery, an endoscopy, and a sleep study A letter of recommendation from your primary care physician (it must be a doctor that is not located within your surgeon’s practice) Also, please remember that there may be other or lesser requirements than those listed above. Again, each insurance company’s requirements are different so you want to be sure to check with them to find out what your specific requirements will be.
Now, once you’ve figured out what you gotta do to have your gastric sleeve cost covered, you’re probably wondering just how long all of this takes . I’m sure you already know that it isn’t an immediate process.
This is a question to ask your surgery team, because aside from insurance requirements, they may have requirements of their own. Normally, It takes several months to a year to get all of this done.
Seriously? Yup. But the time is going to pass anyway, right? My advice is to take it one appointment at a time. It goes faster than you think!
The Approval Process Once you’ve gone through all of those appointments and tests, it will be time for your surgeon to package up your info and submit it to your insurance company for approval.
This can be one of the most stressful parts of the whole journey! But your surgeon’s team should be well versed in insurance approvals.
You will most likely hear Jeopardy music in your head for a few business days before you hear anything back. Personally, my surgeon submitted my info to my insurance company on a Thursday. On Monday I received word that I was approved!
Keep in mind that this timeline looks different for everyone and can sometimes be delayed. But generally speaking, you should get approval within 3-10 business days.
Out Of Pocket It shouldn’t surprise you that the out-of-pocket cost for a gastric sleeve can be hefty. In the USA, gastric sleeve surgery alone can cost around $15,000 on average, not including the pre-op tests and appointments or post-op care. Of course, there are variables that will affect how much you end up paying.
Location – Staying local or traveling to another city or state? Having surgery at a nearby hospital or going to private bariatric practice? This will change the cost of your gastric sleeve. Not surprisingly, a private practice (which may offer out-of-pocket payment plans) will usually cost a great deal more.Complications – You may require additional medical care if complications arise which can drive up the cost. This can include additional doctor visits, hospital stays, or procedures. Your surgeon should discuss all risks before you have surgery so that you know what complications are possible.Extended Care – Sometimes your surgeon’s program will include the cost for your post-op care up until your one-year post-op check-in. If it is not included in the initial price, you will be responsible for forking out payment for these appointments as well. It is very important to keep up with your medical team after surgery, so you should always plan to include this when determining the cost.Out Of Country It is increasingly common for people to travel outside of the USA for bariatric surgery. Not surprisingly, cost is among the top reasons. “Are you crazy?” That’s the response I gave a friend who decided to have her surgery in Tijuana. But after some probing and personal research, it made sense.
She didn’t qualify under her insurance company’s guidelines. Her only option was a local weight loss surgery clinic that offered out-of-pocket options but it was going to cost her up to $35,000 when all of her testing, evaluations, and pre/post-op care was set and done.
The Pluses Having surgery outside of the country has several benefits:
It is a more affordable option if your insurance won’t cover you. The average gastric sleeve cost in another country (most commonly Mexico) ranges between $4000-7000. There is no lengthy program to follow. As long as you meet the practice’s requirements, you can generally book your surgery as soon as they have openings. Requirements for surgery can be less stringent. In a survey of my own peers who traveled outside of the country for their gastric sleeve surgery, they all said that the BMI requirement was 35 or higher. No comorbidities are necessary. *every surgical practice will have its own policies so please check with them directly The Minuses Before you hop on a plane to Tijuana based on gastric sleeve cost alone, there may be some drawbacks .
Firstly, there may be a communication barrier. If you do not speak the native language in the country you are traveling to, you will want to have a plan in place.
Does the facility you are traveling to offer translation services? Do their staff members speak English? Is there a friend or family member who is fluent in the language who is willing to travel with you? Next, you need to be aware that medications may not be up to par and may even be fake.
Ask questions about the pharmacological care you will receive. Check into the regulations the country has in place for the manufacturing and distribution of medications. Also, you are financially responsible for any medical care you receive, even if it was an unforeseen cost or emergency care.
Discuss all possible additional costs with your team before you go. Even if you purchase an all-inclusive procedure, there is a chance that you may need other tests or medications. Find out what their emergency care system is like and what will be required of you should you need those services. Payment may (and usually is) required in full upfront. You will also want to see what their laws are on the refusal of care because of inability to pay. In addition to the above, flying after surgery can increase the risk for blood clots. You may also be at risk for bacterial infections that we aren’t normally exposed to here in the states.
Choosing to have gastric sleeve surgery outside of the USA is a deeply personal choice. If it is something you are considering, please do extensive research and discuss your decision with your primary care physician.
They will be able to help you weigh the pros and cons and make a fully informed decision.
That’s A Wrap Gastric sleeve cost can be a major stressor! Is it worth the investment? Most gastric sleeve patients would say: absolutely. You can’t put a price on your health. If you’re a numbers person, just think about how much money you will spend over the long term.
Managing obesity related diseases isn’t cheap!
If you take the time to do some deep digging (which you should be!) before you have surgery, you should be able to find a plan to cover your gastric sleeve cost without going completely broke.
There are many resources out there that can help you, you’ve just got to ask! Your surgeon’s team is a great first step to get more information about payment options.
You aren’t obligated to the first surgeon you see; if you need to shop around and gather info, do it.
Choosing to have weight loss surgery is one of the biggest decisions of your life. So many things go into helping shape your final decision, and the cost is definitely one of them. But it isn’t the only thing.
Make A Plan For Your Plan.
I encourage you to map out the entire process! Write it down. Getting to the operating table is a process. Which steps along the way are the most important to you? The most stressful?
Write out how you will handle them. Keep researching until all of your questions are answered. Then, you will be able to make the best decision for yourself.