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Patients often need a quiver full of tips and tricks to make bariatric weight loss surgery more affordable. Unfortunately, no single strategy works the same way for every person.
Getting your insurance plan to cover the cost is the prominent place to turn. People enrolled in public Medicare (over 65), or Medicaid (low-income) plans have the best chance of success. Meanwhile, those with private coverage have a 50/50 chance depending on the state where they live.
People paying the full cost without insurance can turn to finance, free clinical trials, grants, or a short vacation to Mexico to find the cheapest surgical center.
Best wishes to a slimmer, healthier you.
How to Pay for Bariatric Surgery without Insurance
Paying for bariatric weight loss surgery without insurance requires creativity. The average cost of each procedure type is very high when you must pay the entire amount out-of-pocket.
- Gastric bypass – $24,000
- Gastric balloon – $8,150
- Gastric sleeve – $19,000
- Lap band – $15,140
Many people do not have this type of money on hand. Therefore, look under every possible rock.
Financing procedures such as lap band or gastric sleeve is the primary way many patients pay for bariatric surgery without insurance. With a financing arrangement, a third party company funds the procedure, and the household repays the company over time using a monthly payment plan.
Request a personal loan here to fund your operation. By taking out a loan, you gain the flexibility to choose the surgical center with the best prices and most competent staff of doctors, nurses, and anesthesiologists. On the other hand, patient finance companies lock you into the referring “in-house” provider.
Borrowers with bad credit find it more challenging to qualify for approval and or the most favorable terms. An adverse history appearing on your consumer report leads to a low FICO score, which suggests a higher default risk. Two strategies can help you compensate.
- No credit check lenders use alternative consumer reports that consider non-traditional data sources such as rent and utility payment experience.
- Demonstrating high-income relative to the projected monthly payment improves your DTI ratio and encourages lenders to say yes to your request.
Free Clinical Trials
Free clinical trials for weight loss or gastric bypass surgery can help just a handful of morbidly obese people each year. Clinical trials recruit patients meeting narrow criteria who might be willing to undergo an experimental treatment. In exchange for acting as a test subject, the doctors provide pro bono services that do not require insurance.
The challenge lies in finding a free clinical trial that matches your exact medical condition, previous dieting and exercise regimens, and geographic area. The doctors may run various experiments and test new devices and therapies.
Several online databases point potential clients to possible studies.
Finding the cheapest bariatric surgery is another way to pay for the procedure without insurance. For patients residing in the United States, the lowest-cost providers are often in another country such as Mexico.
Many surgical centers are located in Tijuana, Mexico, which is a short drive south of San Diego California. Establishing in Mexico allows the centers to charge significantly less because the regulatory, legal, and insurance requirements are laxer.
Be sure to factor in your travel expenses (airfare to San Diego, passport, hotel, ground transportation, and other costs). Also, do your homework on the medical qualifications of the doctors. The word cheaper does not fit well with cutting you open with a scalpel. The phrase “most capable” works much better.
Low-income individuals can often get help paying for with weight loss surgery indirectly. Two government-sponsored welfare programs provide low-income households with access to affordable health insurance – which may cover a large portion of costs – based on where you live.
- Medicaid provides low-cost health insurance for low-income families. Apply for the coverage at your local county office. Be prepared to provide information about earnings and resources.
- Private health insurance comes with subsidies to help low-income families who earn too much money to qualify for Medicaid. Apply for coverage during open enrollment via the healthcare.gov website.
Keep in mind that these options for low-income patients vary by state. See the section below on state coverage mandates to find out if either of these options will help based on where you live.
Both the federal government and private organizations provide grants that can help pay for bariatric surgery without insurance. An open mind will yield the most significant savings.
The federal government does not provide grants to individuals directly. However, most obese patients can reduce their out-of-pocket costs significantly because the government makes the expenses tax deductible.
- Flexible spending accounts offer first dollar tax savings on the amount you contribute each year. Pretax payroll deductions for eligible medical expenses minimize what you pay in FICA, state, and federal income taxes.
- Deduct all your eligible medical expenses on Schedule C. Amounts above 10% of adjusted gross income reduce the taxes you owe. Many taxpayers will benefit, given the high average cost of any procedure.
The Weight Loss Surgery Foundation of America (WLSFA) provides grants to a tiny group of recipients. The WLSFA has funded over twenty surgeries since forming in 2010. Twenty over a span of ten years works out to two people each year. Charitable foundations often have minimal resources.
To qualify for the WLSFA grant, you must complete a financial questionnaire, provide references, and provide written evidence of three types of denials.
- Personal loan
- Public assistance
Weight Loss Surgery Insurance Secrets
Bariatric weight loss surgery insurance secrets are as difficult to explain, as they are to understand. This elective procedure falls into a gray area. Besides, the rules have many exceptions and variations based on location, point-of-service, and source of coverage.
Follow along to unravel the mystery about the public (Medicare and Medicaid) and private plans in your state.
Under the Affordable Care Act, each state determines benchmark coverage essentials for private health insurance plans. Therefore, the state where you live is the first secret for deciding whether you can obtain healthcare for a variety of obesity-related services.
- All 50
- No premium surcharge for being overweight according to BMI measurements
- No consumer cost-sharing for obesity screening and counseling services
- 23: required to cover bariatric or bypass surgery
- 16: include nutritional counseling and therapy
- 7: diabetes-related diagnosis or treatment
- 3: required to offer coverage for bariatric surgery
- 24: no mandates to pay
As you can see, people living in close to half of the states may encounter a bariatric exclusion in their insurance plan. The only way to get around the exclusion would be to move to another state, find group coverage through a new employer, or convince the claims department that treating related diseases is more expensive.
Many individual health insurance plans will cover weight loss surgery in general, but not every procedure. Therefore, the second secret is choosing a covered approach. Many carriers follow the Medicare guidelines for the techniques considered proven and effective versus experimental. However, each plan has unique guidelines.
- Covered Techniques
- Open and laparoscopic Roux-en-Y gastric bypass (RYGBP)
- Laparoscopic adjustable gastric banding (LAGB or lap band)
- Open and laparoscopic biliopancreatic diversion with duodenal switch (BPD/DS)
- Non-Covered Techniques
- Open vertical banded gastroplasty
- Laparoscopic vertical banded gastroplasty
- Open sleeve gastrectomy
- Laparoscopic sleeve gastrectomy
- Open adjustable gastric banding
Also, carriers rarely cover the latest technological breakthroughs. They deem the approaches as experimental until proven otherwise.
- POSE (Primary Obesity Surgery Endoluminal) is a new (experimental) approach that does not require an incision.
- VBlock Therapy is a breakthrough (experimental) approach that uses a vagal nerve stimulator to make you feel less hungry
Knowing the approval requirements is the third secret for getting private health insurance to pay for weight loss surgery. Obesity or the desire to improve your appearance is not a sufficient reason to approve the procedure. Your doctor must document a chronic comorbid disease that the operation will alleviate.
Most healthcare plans follow Medicare guidelines.
- Body-Mass Index (BMI) greater than 35
- Previous unsuccessful medical treatment for obesity
- At least one comorbidity related to being overweight
- Hypertension: high blood pressure
- Dyslipidemia: elevated lipids in the blood
- Type 2 diabetes: non-insulin-dependent
- Coronary heart disease: plaque buildup in arteries
- Stroke: blocked or burst blood vessel feeding the brain
- Gallbladder disease: cholesterol gallstones
- Osteoarthritis: eroded cartilage in joints
- Sleep apnea: breathing repeatedly stops and starts
Key approval tip: Patients must file paperwork containing an ICD code before requesting pre-certification for bariatric surgery. The documentation establishes the history of the qualifying co-morbid condition with the company. ICD Codes (International Classification of Disease) describe the sickness or trauma leading to bodily harm.
Medicaid covers weight loss surgery in most states, excluding Mississippi and Montana. Also, four other states limit access to members of a Health Maintenance Organization (HMO).
- California: MediCal
- New Hampshire: NH Healthy Families
Low-income families in the remaining states can have access to this care, assuming they meet the approval requirements and provide the correct documentation as requested.
How long does it take Medicaid to approve weight loss surgery? The approval time will vary based on the requirements in your state, and your ability to provide the requested documentation per their instructions.
Patients are in control of gathering the required documentation. Therefore, you can shorten the approval time by collecting the needed evidence in advance. In most cases, the documentation establishes the previous unsuccessful medical treatments for obesity.
Finding doctors that accept Medicaid for weight loss surgery is a second challenge. Fewer doctors accept Medicaid patients because the reimbursement rates are meager, and members often book appointments and fail to show because of transportation, work, and childcare conflicts.
Also, four states offer bariatric surgery coverage through Health Maintenance Organizations (HMO) only. By design, HMO plans have very narrow networks. For example, California restricts access for Medi-Cal members to an HMO. Source
However, you can find a list of participating providers on the website of the insurance company managing your plan. Enter the name of your Medicaid plan on the doctor finder page.
Medicare covers weight loss surgery in all 50 states. However, Medicare covers only a small portion of people. You must be over the age of 65 or have a permanent disability to enroll in this public health insurance program.
The Centers for Medicare and Medicaid Services (CMS) publishes detailed guidelines on the qualifications for bariatric surgery. Many private insurers follow these parameters when making precertification and claims decisions. See the covered procedures and approval requirements sections above for the CMS sourced rulings.