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Sorry if this has been discussed on here but I suck at the search thing. In regards to this surgery is it typical for insurance companies to not pay for the surgery, even if medically necessary? And for those who pay for it themselves does anyone know what to expect in overall costs? I'm assuming if the ins co won't pay for the surgery then they likely won't pay for medicines/appointments as well?
Sorry if this has been discussed on here but I suck at the search thing. In regards to this surgery is it typical for insurance companies to not pay for the surgery, even if medically necessary? And for those who pay for it themselves does anyone know what to expect in overall costs? I'm assuming if the ins co won't pay for the surgery then they likely won't pay for medicines/appointments as well?
When I worked at a hospital with a job related to the charges (about 8 years ago) the actual price for the procedure itself was around $30,000 - that was for the doctor's professional fee and nursing staff, allocated days of stay at hospital, etc. Now, there were other packages that included pre and post visits, etc. It really ends up being much more money if you take in account any potential complication you may have.
Is Bariatric something you are considering? Have you tried healthy eating before taking this step? I was told that this type of surgery is major, and it's a complete lifestyle change. You need to try to lose weight even before the actual surgery to get you in the habit of eating healthy.
I'm not a bariatric surgeon but I'm pretty sure insurance pays if you are "morbidly obese." Normally this means BMI>40. Possibly also if you are very obese >35 but have other medical problems such as metabolic syndrome or diabetes. Sure it comes down to your insurance at the end but some definitely do pay if you meet the criteria.
Also I think it is an amazing surgery. Sure you can diet and exercise and lose the weight but the reality is that 99% of people are not going to be able to do that. Interestingly, I remember being in a grand rounds lecture once and a bariatric surgeon said the #1 predictor of success in his patient's long term weight loss from surgery is the willingness to diet to lose weight. Because if you don't change your eating habits you will gain the weight back.
The best way to find a definitive answer to your question is to make an appointment with your general doctor and get a referral to a bariatric surgeon. He/she will be able to tell you if insurance will pay.
When picking a bariatric surgeon make sure you pick someone who does this all day every day. There are plenty of people who do. You want to go to a bariatric center of excellence. That means they have docs who have tons of experience with low complication rates.
The cost varies by location. Here in Salt Lake City, the price is about $20K if you are self-pay. Mine was billed to insurance at$43K but I also had a liver biopsy and 4 days in the hosp. There are companies that will loan you the money if you qualify.
It is definitely not cheap, but is worth it if you can afford it. I believe the cost is somewhere around $30-35K and that doesn't include the follow-up appointments. If you do decide to go that route, stick to the gold standard, which is the Roux-en-Y. The lap band allows for too much cheating and you most likely will if given the option. My feeling was I was my worst enemy, so I needed the surgery that took me out of the equation and it did. Down about 135 pounds since last August and never going back there.
I would be concerned about your ins. not covering, I have a friend who had the procedure 2 years ago, he is still in ICU today. Where would you be if you had a complication? Your loved ones would be strapped with unbearable cost. I'd take the $30,000, and hire a cook, and a personal trainer, and a behavior coach, to help me stick to my goals.
some insurances cover, some dont, some only cover if certain requirmetns are met (ie bmi, presurgery medical issues called co-morbitities, evidence of previous dietary efforts failing (ie 3 years of weight watchers, under dietician supervision ect...)
then some insurances will only cover certain types of bariatric surgery, some will only cover full bypass (Roux-en-Y)
others will do the gastic sleave or lapband...
some insurances will only cover the surgery if its performed by a "center of excelence"
in terms of cost:
1 freind had Roux-en-Y in mexico, cost her $500 for the return flight, $125 for a night at a hotel in mexico, and $22,000 for the surgery and 1 night at their medical facility.
1 frined had it done in the us (this price would vary by state, she was in ny) cost $30,000 including all preop bloodwork ect, but didnt cover the 1 dietary visit and the psych eval, both of which her surgeon required to procede), dietary was 1 hour at $125 an hour and the psych eval was $150 an hour and aparently took almost 3 hours.
I personally had it done insurance covered (blue cross blue sheild), insurance covered everything except co-pays...total after co-pays deducted was $40,000, this included 3 preop dietary visits, a psych eval that only took 1/2 hour, all blood work and presurgery visits, and 2 sleep studies (i had severe sleep apena) plsu all the other back and forths...it also included the surgery (laprascopically done) and 3 days 2 nights in the hospital.
my co-pays were $25-30 per visit (though bcbs reacently raised their co-pays) plus $100 copay for the surgery itself.
all together my share was about $1000. so the total was $41,000.
your best bet would be to call your insurance to find out if they do cover bariatric surgery if your serious about this and see what their options are...they may simply have strict pre-approval processes that include drs referals ect...
i would also suggest finding your nearest bariatric center of excelence and contacting them, often insurances that dont normally cover can be swayed into it by a very good center, and the centers of excelence are usually very good about trying to work with you. (not to mention the better choice if your going through with it.
good luck, and if you have any questions feel free to pm me...i had my Roux-en-Y in late sept of 2010 and am down 119lbs in almost 8 months. (though still a ways to go!)
Nice to hear of someone else that has lost about the same amount as me and in nearly the same amount of time. I had mine on the first of September last year and am down around 130 pounds. I'm done, though, and have been for almost a month or so. Now I'm just trying to figure out the routine that will keep me where I am without any gain or loss spurts. I gained about 4 pounds last week while I was sick and unable to exercise and lost about 6 pounds in four days last month because I went on vacation and apparently didn't think too much about food.. Still the best thing I ever did and I'll recommend it to the end, which will hopefully be MUCH later than it would've been..
BTW, I put on some jeans today that were tight before my surgery and it wasn't even funny. It was absolutely amazing because there was no way they could stay up on me. I probably could've fit two of me in them and that's been the best thing yet. For some reason I still have a difficult time seeing a thin guy in the mirror, but me inside those pants was a serious shock.
rd2007 i understand that, i have body dysmorphia, not enough to cause a real problem, but still look in the mirror and see a 320lb person.
but im down from a 28 to a 14 in my jeans (womens obviously...) its just my brains not making the conenctions yet lol.
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