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Insurance & Payment Options

Weight Loss Lady

For many people, weight loss surgery is covered by their health insurance plan. Bariatric surgery is covered by insurance policies when the patient is morbidly obese, if surgery is "medically necessary," and it can be established that the patient has attempted and failed at previous weight loss trials.

People without insurance coverage for bariatric surgery must pay for it themselves (self-pay). Even without insurance, many people feel that the surgery is worth the investment in their health and seek out alternative financing options.

Below are some tips for exploring payment options, and steps you can take to afford this life-changing surgery.

Your bariatric surgery team is here to help and advocate for you through this process.  Working with your navigator you can find out whether you can afford this life transforming procedure.

How much does bariatric surgery cost?

The cost for bariatric surgery will vary depending on your insurance provider and coverage, your other health considerations, and the providers you choose for various pre-operative testing, counseling, etc.  Your bariatric team at WakeMed Physician Practices will work closely with you to estimate your costs, but they cannot guarantee the exact expenses for all required components since WakeMed may not provide all services required before and/or after surgery and every case and every patient is different.  However, here is a basic overview of the costs associated with weight loss surgery.

WakeMed Cary Hospital Self-Pay Surgery Prices (Surgery Only, does not include any other services)

  • Laparoscopic placement of gastric band - $13,100
  • Laparoscopic sleeve gastrectomy (gastric  sleeve) - $16,300
  • Laparoscopic Roux-En-Y gastric by-pass - $21,200

*Note:  If charges exceed twice the above rates, the policy is that the patient will be billed after the surgery for an additional amount that equates to 50% of those charges that exceed twice the above rates.

Again, pricing for insured patients will vary depending on your coverage.  Work with your bariatric team to estimate your expenses.

Other Expenses

Please note that all patients are responsible for payment related to their Bariatric Fitness and Wellness weight management programs. WakeMed's basic Fitness and Wellness package will be a non-refundable fee of $160. Other services are available at additional costs.

What can I do to prepare?

Whether you have health insurance or opt for self-pay, you will need to prepare detailed written documentation. This will be helpful for both insurance purposes and for your bariatric surgeon and weight loss team.

  • Gather medical information from your primary care doctor regarding any cardiac or pulmonary evaluations you may have already had.
  • Complete your new patient form.
  • Complete your weight loss history form.
  • Read and review your handbook.
  • Take the band or bypass quiz found in the back of your handbook.

Understanding Your Insurance Coverage for Weight Loss Surgery

It can be intimidating and confusing to work with health insurance companies. If your bariatric surgeon recommends surgery, start with these steps:

  • Talk with your bariatric team, especially your coordinator. He/she may be your best resource for working on your behalf and dealing with your health insurance company.
  • Read your Certificate of Coverage. It will describe your insurance policy in detail, including what it does and does not cover.

Appealing a Weight Loss Surgery Insurance Plan Denial

If the insurance company turns down your request for bariatric surgery, you may be able to appeal the decision. Many people do not take advantage of the appeals process or know of the laws that govern insurance companies in their state. Again, work with your bariatric program team for help in figuring out the best approach to appealing a denial of coverage.

Even if you are unsuccessful with your appeal, you still may have options such as independent review boards, arbitration or litigation.

Alternative Financing Options for Weight Loss Surgery

Few people are able to pay cash up front for bariatric surgery. If you do not have health insurance coverage for bariatric surgery, there are alternative financing options available, such as medical loans. You also may wish to explore the possibility of personal loans, such as home equity loans. When it comes to self-pay, you also should consider the expense of potential surgery-related complications because these may not be covered by your insurance either.

  • Home Equity or Mortgage Loans: Another option that some patients have used is a home equity loan or a mortgage. These options may offer better interest rates, but should be pursued cautiously since you would be borrowing against your home.

Note:  The IRS considers weight loss surgery a major medical expense and may be tax deductible. Consult with your tax advisor to learn more.

 

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