Bariatric Surgery Costs in Oregon

Self-Pay Bariatric Surgery

“What if?” you might wonder. Isn’t it a question we ask ourselves all the time? Obesity comes at an exorbitant price. It is costly to our country and to you. Consider this: How much money would I save each year if I didn’t have to deal with this issue? What kind of savings could I make on food, medicine, and plus-size clothing? This tool will assist you in understanding the true costs associated with obesity, as well as the fact that having surgery will almost certainly save you money.

In two years, most consumers see a return on their investment in the form of cost savings on food, medication, and clothing. What greater investment in your long-term health can you make? Stop asking yourself “What if?” and start asking yourself “Why not?” Get in touch with Oregon’s top weight loss surgery team to start your weight loss journey!

Do health insurance plans really have you covered?

It’s a sad fact that about half of the people who contact us about weight loss surgery have a health insurance coverage “exclusion.” To put it another way, their medical insurance plan has purposely decided not to cover weight loss surgery. Most people are naturally depressed by this, feeling that they have no other alternatives.

Take heart: this is a very common issue, and while our bariatric surgeons are advocating for a solution, this doesn’t mean you’re stuck. We have your back, even if your insurance provider doesn’t. We’ve developed a great system of financing options to help self-pay patients and make bariatric surgery affordable for everyone.

It’s inconvenient when your automobile breaks down, but you can always trade it in for something new. Unfortunately, your body does not function in this manner. Now is the time to take care of it, and paying out of pocket doesn’t have to be as scary as it seems. So make an appointment, consider your alternatives, check into payment possibilities, and see how to make weight loss surgery viable for you.

What are the advantages of self-paying?

Despite our efforts at Bay Bariatrics to provide all bariatric patients with the same high-quality care, many patients still prefer the clear control and more direct process of cash pay even if they can get insurance approval. These patients value the clarity of expectations and complete lack of ambiguity that comes with working directly with Bay Bariatrics rather than through a third party (the insurance company), even if insurance options are available.

Others will opt for self-pay for another reason: their insurance company may cover this surgery under certain plans, but the patient is not on the right plan. This is a difficult position; after all, obesity is a sickness, but it is a reality not acknowledged on certain health insurance policies.

Others have crunched the numbers and determined that, despite the fact Bay Bariatrics being out-of-network, the cost and quality of services make self-pay worthwhile.

Simply put, there is no single reason why a patient chooses cash pay for their own care, but a number of factors may influence their decision.

Is Weight Loss Surgery Affordably Available For Low-Income People?

If you have researched available interventions, explored your insurance options, and believe self-pay is the way to go, we sincerely hope that upfront costs are not a barrier in preventing you from following through. Low income, unfortunately, can be both a risk factor for obesity and a barrier to weight reduction procedures such as gastric sleeve surgery. We believe you deserve a route out of what might feel like a catch-22 situation and work with our bariatric patients to get there.

No matter your income, employment status, or insurance status, we assist you with your financing options and help you move forward with the most appropriate solution for your situation. Depending on the specifics of your plan, a health FSA will cover a wide range of qualified costs associated with weight loss surgery. Under the standard health FSA, bariatric surgery such as gastric banding, gastric sleeve surgery, and gastric bypass surgery is covered, assuming you have appropriate documentation by a physician recommending the surgery as a treatment for a medical condition.

You’re making a significant investment in your future when you choose to have bariatric surgery—one that will pay off for the rest of your life. Bay Bariatrics is dedicated to keeping the cost of our surgeries as low as possible.

Will My Insurance Pay for Bariatric Weight Loss Surgery?

Although many health insurance companies recognize the long-term benefits of bariatric surgery and will cover weight loss surgery, each company has its own set of criteria for approval. Our office staff can help you find out if your insurance covers bariatric surgery. If your insurance policy does cover bariatric surgery we need formal prior authorization from your health insurance company for the procedure before you can undergo weight loss surgery. This is true in every situation. Your insurance company will require written evidence of the medical necessity for surgery to obtain bariatric surgery insurance coverage. The pre-approval process for your weight loss surgery might take anywhere between 1-6 months, depending on your insurance company’s specific criteria. We can assist you with preauthorization for your bariatric surgery, so get in touch with us now.

“Will my health insurance pay for weight loss surgery” is one of the most common questions we receive. When approving a patient for bariatric surgery, most major insurance companies use the same criteria. Your insurance coverage can be based on many factors, and it is best to contact your insurance provider directly to learn more about your specific bariatric surgery coverage. Different insurance companies and policies cover different procedures, but, in general, most insurance companies will at least partially cover the major weight loss surgeries: gastric bypass surgery, gastric sleeve surgery, and laparoscopic banding surgery.

The following are some of the most typical requirements for insurance coverage:

• Have a BMI (body mass index) of at least 40, or a BMI of 35 or higher with one or more obesity-related comorbid conditions (calculate your BMI).
• A psychological evaluation.
• A nutritional evaluation.
• A three to six-month medically supervised diet program.
• A reference from your primary care physician is required by some insurance companies to cover bariatric surgery.
• A weight history from your primary care physician demonstrating that you’ve been overweight for a long time.
• A letter from your primary care physician stating that weight loss surgery is medically necessary.

Some insurance companies simply require the top three, while others demand all seven. Because every insurance policy is different, we assist you in understanding your specific insurance requirements and facilitating your weight loss journey.

Even with insurance “hoops,” the bariatric surgeons at Bay Bariatrics strive to make your weight loss surgery experience as painless as possible. We will accompany you on your weight loss journey at all times, ensuring that you never feel alone or lost.

Dr. Tersigni and Dr. Rogalsky understand how important it is to lose weight to not only feel better about yourself but also to reduce weight-related health problems associated with morbid obesity such as sleep apnea, coronary heart disease, and high blood pressure. Many people have failed at losing weight on their own and, despite their best weight loss efforts, have found themselves categorized as morbidly obese. Obesity surgery is often the best option for these individuals to achieve long-term success in losing weight. Severe obesity is a medical disease, and many health insurers have begun to recognize that. We will do everything we can to work with your health insurance carrier to make sure your weight loss surgery is covered by insurance.

Does Medicare Pay for Bariatric Weight Loss Surgery?

As the obesity rate in the United States rises, so does the demand for Medicare coverage of bariatric weight loss surgery. Many patients ask us frequently, will Medicare cover bariatric surgery. Medicare covers various bariatric weight loss surgeries to treat obesity and related health conditions after meeting certain requirements and receiving approval from a licensed physician.

Despite the fact that Medicare will cover weight loss surgery, the program decides on benefits denial or approval on a case-by-case basis. To be approved, weight loss surgery must be FDA-approved.   Even if a Medicare beneficiary meets the requirements for bariatric surgery procedures, their doctor and Medicare have the final say on whether or not they are covered.

Not every circumstance in life is the same. Regrettably, this implies that coverage may differ from one individual to the next. However, since many diseases are caused by excessive obesity, weight loss surgery is often deemed medically necessary.

Types of Bariatric Surgeries Covered by Medicare

Although Medicare covers a variety of bariatric weight loss operations, not all of them are covered. The following is a list of weight-loss operations that Medicare covers:

• Sleeve Gastrectomy
• Gastric Bypass
• Duodenal Switch
• Laparoscopic Adjustable Gastric Banding Surgery

Gastric Bypass

Roux en y gastric bypass is a surgical surgery that divides the stomach into tiny sections in order to reduce calorie intake. Medicare may reimburse gastric bypass surgery after an obesity screening, including a BMI test and counseling. You must, however, fulfill the morbid obesity standards and pay any deductible charges.

Sleeve Gastrectomy

When your doctor deems it medically necessary and you meet the bariatric requirements, Medicare will cover sleeve gastrectomy surgery.

This treatment, also known as gastric sleeve surgery, involves removing and separating around 85 percent of the stomach. The remaining is then shaped into a tubular form that can only hold a little amount of food or fluids.

After gastric sleeve surgery, patients lose an average of 65 percent of their excess weight, which may explain why it is one of the most popular bariatric procedures.

Duodenal Switch

The duodenal switch is a relatively recent operation that is covered by Medicare. DS eliminates a major section of the stomach, similar to the gastric sleeve procedure.

Duodenal switch surgery is covered by Medicare. However, finding a bariatric surgeon to do the treatment might be difficult. Because many surgeons are unfamiliar with this procedure, finding the correct practitioner might be difficult.

Medicare’s Bariatric Surgery Coverage Requirements:

• Obesity is linked to one or more medical conditions.
• Obesity medical records dating back more than five years, as well as a letter of reference from a physician
• Obesity-causing medical diseases have been ruled out.
• A BMI (body mass index) of 35 or greater
• Participation in a medically supervised weight reduction program with documentation
• Passed psychological evaluation

You must fulfill all of the above criteria to be considered a candidate for bariatric weight reduction surgery. Medicare is not required to approve your operation even if you fulfill all of the requirements. Each permission is given on an individual basis.

How Long Does it Take Medicare to Approve Bariatric Surgery Take?

Approval of bariatric surgical procedures by Medicare may be a complex process. Medicare may take three to four months to authorize the procedure from the initial visit to medical clearance.

Medicare Comorbidities for Bariatric Surgery

Comorbidities are disorders that are linked to another health problem. This may sometimes imply that one health concern leads to another. Comorbidity refers to any ailment that arises as a direct consequence of morbid obesity in the context of bariatric surgery. Type 2 diabetes, sleep apnea, hypertension, joint or back pain, soft tissue infections, and other comorbidities are listed by Medicare as major bariatric surgery-approved comorbidities.

If you are morbidly obese but do not have any of the following illnesses, you may still be a candidate for weight loss procedures. You must, however, show that the comorbidity is linked to obesity.

Average Cost of Bariatric Surgery With Medicare

The typical cost of bariatric weight loss surgery in the United States is between $25,000 and $30,000. With Medicare Part A and Part B, those who meet the eligibility requirements and are accepted for coverage will be responsible for the Medicare Part A and Part B deductibles, Medicare Part B 20% coinsurance, and any coinsurance or deductible payments for Medicare Part D.

Inpatient hospital charges are covered by Medicare Part A. If your operation is an outpatient procedure, however, Medicare Part B will cover 80% of your doctor’s services and materials. Then, following your operation, Medicare Part D will pay for any prescriptions that your doctor recommends.

After original Medicare pays, a Medicare Supplement insurance would cover most, if not all, of your out-of-pocket payments. If you have Medicare Advantage coverage, on the other hand, you may have to go through more extensive prerequisites. This is because your coverage will change from that of Original Medicare.

Will Medicaid pay for Bariatric Weight Loss Surgery?

Individuals may need weight loss surgery in a variety of circumstances when other weight loss programs have failed. Obesity can be a difficult problem to solve and can quickly spiral out of control. Bariatric surgeries are the only option for many people’s overall well-being and may be the only way to achieve a healthy lifestyle and weight.

Weight loss surgery is usually covered by Medicaid. For Medicaid to cover weight loss surgery, the patient must meet the basic coverage requirements. Bariatric surgery coverage is not extensively discussed in the Medicaid eligibility guidelines and is generally handled on a case-by-case basis. You’ll need to talk to your doctor about the Medicaid coverage application procedure.

How much does Medicaid pay for bariatric surgery?

When Medicaid approves bariatric surgical procedures, full coverage of the weight loss surgery is usually provided. Another alternative to help with out-of-pocket costs is to purchase gap insurance or additional insurance to cover any areas not covered by Medicaid. You may supplement any extra amount with different insurance carriers if you have gap coverage.

Medicaid Eligibility Criteria for Weight Loss Surgery Cost Coverage

You must meet all of the following criteria in order for Medicaid to fully cover the cost of your surgery as well as any associated visits with your surgeon.

• You will need to be over the age of 13 if you’re a female or over the age of 15 if you’re a male.
• Your Body Mass Index (BMI) must exceed 35, and you must have at least one comorbidity, such as high blood pressure, sleep apnea, high cholesterol, or diabetes.
• If you are below the age of 21, you need to have a Body Mass Index (BMI) exceeding 40 with at least one of the aforementioned comorbidities.
• You must have a printed letter from your primary care physician recommending the medical necessity of weight loss surgery.
• You need to pass a mental health exam showing that you are capable of adopting the necessary lifestyle changes for weight loss.
• You must be able to provide documentation showing that you have tried to manage your weight and comorbidities using standard treatment but that those attempts were unsuccessful.
• You must complete a medically supervised program for weight loss spanning six months, and you need to show documentation that this weight loss program was attempted within the past 12 months before surgery.

Medicaid will not cover weight loss surgery for certain people. You will not be eligible if you have any of the following illnesses or conditions.

• Long-term use of steroids
• Malignant cancer
• Chronic pancreatitis, inflammatory bowel disease, or pregnancy
• Certain Digestive and Kidney diseases
• Non-compliance with medical treatments
• Psychological treatment that could interfere with your new diet and lifestyle

Which weight-loss treatments are covered by Medicaid?

Lap band surgery, gastric sleeve surgery, and gastric bypass surgery are all covered by Medicaid in most circumstances. In certain cases, they are deemed as medically necessary bariatric procedures for the patient’s survival and well-being.

How do you get Medicaid to approve bariatric surgery?

Your surgeon can explain to you about your state’s Medicaid program and whether Medicaid services cover weight loss procedures for obese patients. In general, when there is a medical necessity for the procedure, Medicaid will fund it as a medical treatment for obesity. It is critical to have a physician who can share pertinent information about the patient’s medical need for bariatric surgery with Medicaid.

The bariatric surgeons at Bay Bariatrics can help you understand what type of surgery is right for you. After you’ve made your decision, you’ll need to undergo some tests and then check with the Medicaid office to see if the bariatric surgery is pre-approved. The approval process is lengthy and involves both patience and effort.

Before receiving approval, you may be required to attend classes to learn about the surgery and undergo nutritional evaluations, lifestyle changes, and post-operative exercises in order for Medicaid to cover bariatric surgery. This ensures that the patient is aware of all the implications of the surgery as well as what is required for it to be successful.

You should check with your local Medicaid office to see what parts of the surgery may or may not be covered by Medicaid. In general, if your doctor can prove bariatric surgery is medically necessary, Medicaid will most likely cover it.