How to Get Around Bariatric Exclusion

(Updated Sept. 13, 2022)

 

Obesity is easily one of the greatest threats to the health of America. Costs associated with obesity in this country are nearing an estimated $200 billion every year, including direct costs such as surgeries and medications, and treatments of certain diseases.

Indirect costs (including loss of work from short-term absences and long-term disabilities) play a part in the overall health care price tag too. Unfortunately, some insurance companies view bariatric or weight loss surgery as something other than a medical necessity. This is often referred to as a bariatric exclusion in certain plans.

Plans may also charge more to cover weight-loss surgeries or procedures. At least half of the people in the United States get their health care insurance through their employer. Bariatric exclusion is one way to keep their health care costs lower for their employees.

YOU CAN AFFORD WEIGHT LOSS SURGERY

When you have obesity-related health problems, you can achieve weight loss effectively through bariatric surgery. However, one of the most common reasons people don’t pursue weight loss surgery is finances. But you may be surprised how affordable weight-loss surgery really is. We have some insight on how to pay for weight loss surgery without sacrificing the quality of care.

It is important to know that bariatric surgery can be life-changing and, in some cases, lifesaving. The key here is to take steps towards your health by taking advantage of financing options available to you. We believe that anyone who requires weight loss surgery should have the opportunity to pay for it.

How to Pay for Weight Loss Surgery: Think of the ROI

Bariatric surgery is an investment in your health. Due to the many conditions that arise from long-term obesity, you can expect lofty medical expenses as you age if you don’t address your weight. This is an important point to consider when analyzing the costs of weight loss surgery.

The average costs for medications for type 2 diabetes, including prescriptions, insulin pumps, and other associated care, can reach thousands of dollars every year. It’s been shown that bariatric procedures such as gastric banding or duodenal switch can lead to the remission of diabetes.

Weight loss surgery can also help with sleep apnea and the costs associated with that disorder. Medicine, CPAP machines and maintenance, and other financial considerations can be a thing of the past with the help of bariatric procedures. In the long run, if you can lose weight through bariatric surgery and keep the weight off, you will save money.

A study published in Bariatric Times stated the following, in regards to the financial ROI of pursuing bariatric surgery:

“The costs of the surgeries are readily offset by the benefits. Although there is some disagreement about expenditures and savings, most economists concur that the cost of surgery is amortized over 2 to 3 years, mostly due to the sharp reduction in medications. The savings in medications for diabetes alone exceed $10,000 per year. Not considered in these analyses are the additional social benefits due to reduction in disabilities and the ability to return to work and be productive at those jobs.”

 

 

How to Afford Weight Loss Surgery: Insurance Coverage

CAN I BUY INSURANCE TO COVER BARIATRIC SURGERY?
Some health insurance plans–like those you may obtain from your employer–may provide coverage for weight loss surgery. This is not always the case, though. You should talk to your health care plan provider to determine the right services for you.

Health insurance may be available to those who do not have any. Purchasing a policy that allows for bariatric surgery is essential. If you are unsure what your insurance options are, talk to a representative from the company. Fortunately, California is one of 23 states that require individual, family, and small group insurance plans to cover bariatric surgery through the Affordable Care Act.

Most people can obtain coverage for bariatric procedures through their PPO or Medicare. Exhaust these possibilities as a first step.

What If Your Insurance Doesn’t Cover Bariatric Surgery?

Not all health insurance plans will pay for weight loss surgery. There are various reasons for this, including physical and psychological issues. If you know you cannot get coverage in that manner, talk to our team about financing the procedure. We can help you to figure out how to pay for weight loss surgery.

If no benefits are offered, patients can reach out to their insurance representatives or employers to seek options to add bariatric benefits to their plan. In our experience, most patients are able to add these benefits successfully.

Additionally, to qualify for insurance coverage for your bariatric surgery, you must meet some specific metrics, including:

• Having a BMI over 35 with obesity-related health issues.
• Having a BMI over 40 (without obesity-related health issues).
• Use our BMI calculator to see if you qualify!

In some cases, you may need to prove bariatric surgery is a necessity. Consulting with a bariatric surgeon will help prove that necessity, but not everyone will meet the psychological requirements needed for bariatric surgery. Weight-loss procedures aren’t to be taken lightly and you need to be in the right frame of behind to proceed.

According to the National Library of Medicine, psychological clearance is a requirement for a majority of health plans:

“Psychological evaluation of patients before bariatric surgery is a critical step, not only to identify contraindications for surgery, but also — and more so — to better understand their motivation, readiness, behavioral challenges, and emotional factors that may impact their coping and adjustment through surgery and the associated lifestyle changes.”

Patients can obtain clearance through their own psychologists or our office can refer out to nearby psychologists if needed.

How to Pay For Weight Loss Surgery: Financing

If you do not have coverage, you can work with a third-party financing company to fund your expenses. To obtain this, the first step is to speak to our doctors about your needs. We’ll provide you with an exam and discuss the best type of weight loss surgery for your needs, risks, and goals you’ll need to meet before going forward. Then, we can work with you to obtain financing for the procedure.

Olde Del Mar Surgical has an established relationship with Prosper Healthcare Lending and Care Credit. Their benefits include:

• Immediate decisions for loans under $35,000
• Longer terms for lower monthly payments
• No collateral required
• No prepayment penalties
• The fast and easy loan inquiry process
• 100% confidential

With this option, you may consider paying for your care in advance. The costs for hospital stays and other medical expenses can seem overwhelming initially. Still, many hospitals and medical facilities will offer substantial discounts to patients who pay for their care in advance. This reduces a great deal of risk for the hospital, and they can afford to lower their prices.

 

WHERE TO BEGIN

The first step is to talk to your surgeon. By doing so, you will learn the best type of weight loss surgery for your needs. Gastric sleeve surgery, gastric bypass surgery, and lap band surgery may all vary in cost. Once you determine the right procedure for you, you can begin developing your financing strategy.

Once we understand what you need, we can help you through health insurance qualifications, financing needs, or self-pay solutions. Our team can provide you with more information about the costs you’ll need to cover. We have helped countless patients figure out how to pay for weight loss surgery, so rest assured that we will guide you through the process.

DON’T LET COSTS STOP YOU: THERE ARE OPTIONS

Don’t let financing stand between you and the health you deserve. Talk to us first and learn about your options. Find out how this type of procedure can improve your life. Once you talk to us, we can work on finding a solution for financing your bariatric surgery.