Weight loss surgery, Gastric Bypass, Free Information - St. Francis Hospital Washington

Navigating insurance policies and figuring out all of the charges surrounding weight loss surgery can be a daunting task all by itself. We have put together some answers to the most common questions below. As always, if you have further questions, please contact your surgeon’s office or the Center for Weight Management at 1-800-823-6525.

Does insurance cover weight loss surgery?
Many insurance plans will help cover the costs of weight loss surgery, but coverage varies according to your medical history and individual insurance benefits of your policy.

If you would like to begin researching your options, you may call your insurance provider and ask them if weight loss surgery is a covered benefit under your specific company policy. Ask for a description of your benefits related to weight loss surgery in general and if only specific procedures are covered. Also, your company may offer different plans from different companies, some of which may cover surgery and some which may not. If your current insurance policy does not cover weight loss surgery, contact your human resources department to see if there is another policy that does.

How quickly will my insurance company approve me for surgery?

All insurance companies have criteria that you must meet before they will approve you for surgery. This criteria may include:

Proof that you are at least 100 lbs overweight or
Proof that you have a BMI of 40 or above or
Proof that if your BMI is between 35 and 40 that you have documented co-morbidities (like diabetes, sleep apnea or other conditions)
Some may require a 6 to 12 month record of unsuccessful, medically-supervised weight loss

Does St. Francis work with insurance companies?
We work closely with many insurance companies to improve our program which results in better outcomes for our patients. The bariatric program at St. Francis Hospital has been recognized by the following insurance carriers as a preferred program due to our experience, excellent outcomes and ability to handle even the most difficult cases.

My insurance company does not cover weight loss surgery. What else can I do?
If your insurance company or specific company policy does not cover weight loss surgery, you may opt to pay for it yourself. There are several financial institutions that provide healthcare financing for weight loss surgery – contact our office at 1(800) 823-6525 for more information.

I am planning on paying for the surgery myself. How much does it cost?

Cost for LAP-BAND or Realize Band surgery
For self-pay patients, the we offer a competitive packaged price of $18,500. This price includes:

surgeon's surgical fee
surgical assistant fee
hospital's surgical fee
anesthesiologist fee
nutritional counseling by a registered dietitian
post-op visits for the first 90 days
your first 1-2 band fills within the first 90 days after surgery

This price does not cover:

pre-op labs and exams to qualify for surgery (your insurance may cover these)
psychologist fee for psychological evaluation
protein drinks and nutritional supplements
additional band fills

Cost for sleeve gastrectomy surgery
For self-pay patients, we offer a competitive packaged price for sleeve gastrectomy surgery of $14,750. This price includes:

surgeon's surgical fee
surgical assistant fee
hospital's surgical fee
anesthesiologist fee
nutritional counseling by a registered dietitian
post-op visits for the first 90 days

This price does not cover:

pre-op labs and exams to qualify for surgery (your insurance may cover these)
psychologist fee for psychological evaluation
protein drinks and nutritional supplements

Cost for gastric bypass surgery
There are different types of gastric bypass surgery and some are done via open surgery or using laparoscopic techniques. Because there are many variables, there is not a specific price for gastric bypass, however, you can expect to pay somewhere between $20,000 and $25,000 for all of your services. Discuss this with your surgeon to get a better idea of the total cost for the specific type of gastric bypass surgery you choose.

Is there any benefit to paying for it myself?
Other than not having to wait for insurance approval, obesity is recognized as a medical disease so the Internal Revenue Service has deemed that out-of-pocket costs for physician-directed weight loss programs are tax deductible.

This is all too confusing. What should I do?
If you have more questions about paying for weight loss surgery through insurance, or about paying for it yourself, please feel free to contact the Center for Weight Management at 1-800-823-6525 or your surgeon's office.