Weight Loss Surgery Options

Your Complete Guide to Bariatric & Weight Loss Surgery

Weight-Loss Surgery Is an Affordable Way to Improve Health

Protecting your health is one of the most important ways to assure a good quality of life. If weight-related medical issues threaten your health, it may help to know that weight-loss surgery has been shown to be safe and highly effective for the treatment of obesity. For severely overweight people, who cannot lose weight through traditional means such as dieting, weight-loss surgery is a proven method of resolving or preventing chronic disease and enhancing one’s quality of life.

Many health insurance plans will pay for some or all of the costs involved in weight-loss surgery. They do this because weight loss, no matter how it is achieved, has been shown to substantially reduce a person’s overall health care usage and expenses. When a person loses a significant amount of weight, the risk of developing chronic and expensive-to-treat illnesses declines, which saves the patient and health care provider money in the long-term.

The first step is to talk to your health plan representative about insurance for weight loss surgery. Coverage for weight-loss surgery rose slightly in 2004, increasing from 23 percent of all employers to 27 percent, according to the National Survey of Employer-Sponsored Health Plans 2004 by Mercer Human Resource Consulting. Among large employers, 50 percent covered the surgery, up from 48 percent the year before. The survey also showed that large employers, who cover weight-loss surgery, are increasingly limiting eligibility to individuals who have complied with a behavior modification program.

In addition to speaking with your health care provider, surgeons who perform weight-loss surgery and their office staff can help patients explore their insurance and financing options.

Every plan is different. Yours may have a list of approved surgeons and hospitals in your area. If you want to use a surgeon who isn’t in the plan, ask about your options for out-of-plan services, and how that may affect costs.

If your plan refuses coverage, you may want to appeal the decision. Your plan representative will have all the details regarding what you need to do to make your case for funding.

If your health insurance is covered by Medicare, as with commercial plans, there are some restrictions on which facilities patients can use in addition to private or commercial health insurance policies. Still, Medicare-dependent people who are considering weight-loss surgery are much better off than they used to be.

Initially, Medicare covered only gastric bypass surgery. However, in February 2006, the program expanded its coverage to include open and laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding and open and laparoscopic biliopancreatic diversion with duodenal switch. However, these surgeries are covered by Medicare only if performed in a hospital or by a practice that is judged by the Surgical Review Corporation to be a Center of Excellence, so be sure to verify that your surgeon is affiliated with one of these centers.

Weight-loss surgery is major surgery. It’s important to feel comfortable with your surgeon and confident that he or she will address the many questions and concerns you will have.

Your surgeon should explain your options carefully and in a way you can completely understand. You may want to talk to several surgeons before you decide who will perform your operation.

Pick a surgeon who is board certified in general surgery and who is affiliated with the American Society for Metabolic and Bariatric Surgery (ASMBS). Members of ASMBS have extensive experience with weight-loss surgery. The surgeon should be an expert in a particular type of surgery or should be able to offer more than one type of surgery, as the specific procedure you choose needs to be matched carefully to your needs.

A surgeon and his or her staff can also devise a life-long weight-loss treatment plan that fits with the coverage your health plan offers or that fits your budget. The costs of surgery and aftercare can be significant, especially if your insurance doesn’t cover weight-loss treatment or leaves you with large out-of-pocket expenses. It’s good to have a surgeon who can help you prioritize your long-term treatment needs and figure out how to best use your financial resources.

If your plan does not cover the cost of surgery and ongoing care, or pays for only part of the cost, you may choose to arrange weight loss surgery financing; what better investment is there than putting your money to work protecting your health and well-being? Also, there can be tax advantages to personally paying for your treatment.

Many hospitals that have specialized weight-loss surgical practices will make financing available to patients through arrangements with local banks. But there are other financing routes. Your financial advisor and surgeon can help you consider your options, which include home-equity loans and the various commercial institutions that have loan programs for medical expenses.

The Internal Revenue Service allows significant deductions for people who pay for weight-loss surgery. You can deduct the amount of any medical expenses that are more than 7.5 percent of your adjusted gross income. The deduction applies to you, your spouse and any dependents in your family. Check with your accountant to find out exactly what portion of your expenses is deductible.

Whether you have insurance, Medicare or are paying yourself, the money and effort you expend on weight-loss treatments can provide a significant payback in the form of an improved quality of life. People with a real weight problem who achieve long-term weight loss experience many health improvements, including better sleep, lower blood pressure and better management of diabetes, to name just a few.

So don’t let the cost of weight-loss surgery keep you from getting the help you need. There are options available for people in many different financial situations. Remember, weight-loss surgeons and their staff are very knowledgeable about the payment options, so be sure to talk with them.

1. Klein S. Outcome success in obesity. Obes Res. 2001;9(suppl 4):S354-S358.

2. National Survey of Employer-Sponsored Health Plans 2004. Mercer Human Resource Consulting Web site. Available at: http://www.mercerHR.com/ushealthplansurvey. Accessed March 26, 2006.

3. United States Department of Health and Human Services. Centers for Medicare and Medicaid Services Web site. Medicare expands national coverage for bariatric surgery procedures. Available at: http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1786. Accessed March 27, 2006.

4. Columbia University Department of Surgery Web site. Surgical options: how to pick a surgeon. Available at: http://www.columbiasurgery.org/divisions/obesity/surgical_how.html. Accessed March 26, 2006.

5. Publication 502. Internal Revenue Service Department of the Treasury Web site. Available at: http://www.irs.gov/publications/p502/ar02.html#d0e237. Accessed March 27, 2006.