Gastric sleeve surgery can help improve your overall health if you’re obese. Unfortunately, this approach (including in Florida) is not always affordable, especially if you don’t have any insurance that covers the operation. To reduce the cost, here are a few helpful information you must read!
First off, does gastric sleeve surgery really work?
As the name suggests, this weight-loss surgery removes part of the stomach to make a new smaller tube-stomach, ‘sleeve’ banana-sized stomach. Typically, more than 60 percent of the stomach is removed, leaving a smaller one about the size of a banana.
But as with most major surgeries, there are a few risks (complications) that may occur after surgery. Some possible short term complications are as follows:
- Digestive discomforts right after the operation such as constipation, nausea, and vomiting.
- The risk of excessive bleeding, blood clots, or infection.
- Counterproductive reactions to anesthesia, especially if your body is allergic to anesthesia.
- The risk of having a leak from the staple line or cut edge of your stomach.
- Trouble in breathing (lung problems).
Also, you may experience some of the following symptoms associated with changes of your body (as you lose weight drastically in the first 3-6 months after the operation):
- Feeling tired, which may come up with mood changes.
- Feeling sick (cold).
- Body aches that may come and go.
- Skin problem (dry skin).
- Hair loss (hair thinning).
And in long term, the operation may have a role to increase the risk of the following conditions:
- Abdominal hernias, a bulge that forms when abdominal tissues protrude trough a weakened /opening spot in the abdominal wall fascia.
- Digestive issues (e.g. vomiting, burning chest pain (gastroesophageal reflux disease), gastrointestinal obstruction, and malnutrition).
- Hypoglycemia, low blood sugar problem.
Fortunately, problems associated with gastric sleeve surgery are usually mild (not serious). But it’s always worth a try to comprehensively understand the risks before the operation. Discus more with your doctor /specialist for more guidance!
Low cost gastric sleeve surgery with insurance
The best way to effectively cut down the cost is with insurance, though there are a few tricky steps you need to go through (it could be a lot of work for approval). More than 80 percent of patients for weight loss surgery in the US are covered with insurance (mostly with private insurance, Medicare, and Medicaid).
Aside from saving more money, here are other benefits with insurance:
- To prepare yourself better. When you deal with insurance, you may need to wait several months (6 months or more) for your surgery, except if you’re in emergency condition. But this will give you adequate time to prepare yourself before the operation. Remember, gastric sleeve operation is a major surgery that can cause major lifestyle changes. You may not be ready enough if you decide today and have the operation next week.
- Typically, complications from the operation (including follow-up appointments after surgery) are also covered.
- Although there are many procedures and tests to get approved, this can also be good to make sure that your operation is safe and successful.
With insurance, you pay for only $3.500. On the other hand, the cost can take a toll of your pocket as much as $ 19.000 without insurance.
But it’s not always easy to choose insurance in Florida. If you don’t have any idea where to start, here are a few recommended ‘low-cost’ options to choose from:
Obamacare weight loss surgery
This US government-controlled healthcare program is a good way for making the operation more affordable. The guidelines of this program require some insurance companies to give coverage for all small group (50 or fewer employees), family, and individual plans.
But you can only get the coverage in states where weight loss surgical operation can be considered an ‘Essential Health Benefit’ option. Several variables are used to determine the category of this essential health benefit, which can vary from state to state. In general, if your state has included obesity surgical treatment before Obamacare program, it’s also more likely to be covered by Obamacare.
You may find it more difficult to get approval in Florida. Even though if your state is not on the list of obamacare weight loss surgery program, try to ask surgeons in your local area. For free, some can help confirm the answer by contacting your insurance company!
If your surgeon confirmed the policy of your insurance doesn’t include sleeve gastric surgery, there are still a few options to cut down the cost. Just keep reading!
It’s another way to help expand your access to affordable health care; including weight loss surgery. The good news, it is available in all states.
But there are certain caveats apply. In general, you’re qualified for this program if:
- You’re 65 or over.
- It’s possible to have approval if you’re younger than 65 of age, but only if you have certain disabilities.
- For any age if you have advanced stage of kidney disease that requires kidney dialysis treatment or kidney transplantation.
And for gastric sleep surgery, Medicare program can help cover the cost (only available for laparoscopic procedure) if you:
- Have BMI (body mass index) higher than 35.
- Have one or more comorbidity conditions related to obesity e.g. diabetes, hypertension, gallbladder disease, stroke, etc.
- And have qualified documentation in your medical records to prove that – you have tried several ways (other than surgery) for obesity, but no one that works successfully!
Also, you’ll have to be referred by a doctor or your primary care physician to make sure that surgery is effective way to improve your obesity health problems. The benefits must outweigh the risks!
For instance, weight loss surgery is not always beneficial for seniors (65 or older). While some studies show surgery is effective way to cope with obesity, sometimes the result could be counterproductive in elderly people. In this group, surgery complications are more likely to occur. Also, the operation may only result less weight loss (lower than expected).
Since each case is different, discus with your primary care physician. Depending on your own situation, you may be qualified to have low cost gastric sleeve surgery with Medicare program (even though if you’re 65 or older).
How about Medicaid program
This state-run program (not available in all states) is established for low-income group (families or individuals). It pays medical advantages directly to health providers (e.g. pharmacies, hospitals, doctors, and other health practitioners) for -Qualified Medicare Beneficiaries-.
Since Medicaid for weight loss surgery is not available in all states, it’s determined on a state by state basis, find out more information by contacting your state’s Medicaid office here!
Coverage insurance through your work
If you work for a company with fewer than 50 full time employees, Obamacare is the best way to reduce the cost. But if your company has more than 50 employees, the decision is completely dependent on your employer.
To find out whether or not your weight loss surgery is covered by your employer’s plan, you can:
- See the Human Resources department of your company. They are usually authorized to give information about your employer plan.
- Contact your local surgeon to help check your insurance plan. They can do it for no charge.
- For more information, directly contact your insurance company. Just make sure to make a phone call with the phone number listed on your insurance ID card.
In case when gastric sleeve surgical treatment is not covered by your employer’s plan, there is still a chance to convince your employer to include it. See your HR (Human Resource) to start your step!
Tell what you need to your HR, explain anything comprehensively. Your HR may be able to add it in your plan if there is a strong argumentation of compelling business variable to do so. So the key is to drive all emotions out of the discussion when presenting a compelling business case.
Some studies show that adding bariatric surgery (like gastric sleeve surgery) in employer’s plan is helpful to boost the bottom line of the company’s income (how much money they eventually make). This can be a good business decision to improve productivity and overall health of employees.
Low cost gastric sleeve surgery without insurance
Although most cases of weight loss surgeries in the US are done with insurance coverage, there is still a quite high percentage (more than 10 percent of patients) had to deal with their savings. In case when you have to pay cash, here are ways to help reduce your out-of-pocket costs.
Benefits with paying cash
- It’s completely up to you to choose your surgeons as long as you can pay them. It’s not dependent on an in-network provider.
- You can choose the facility of your surgery. You don’t have to follow any insurance approved facility.
- There is no a long waiting list procedure. You will get the operation as soon as you and your surgeon are ready! Also, you don’t have the risk of being canceled at last minute due to coverage issues!
What to remember before paying cash
It seems paying cash is more practical if you have enough budget. But don’t forget to also calculate costs of follow-up appointments and treating complications after surgery. The likelihood of serious complications and death is very low after gastric sleeve surgery, but it’s quite possible to have some short and long term complications afterwards!
If there is no policy to cover weight loss surgery in your insurance plan, in all likelihood it also doesn’t cover the costs of complications or health problems associated with surgery (except for emergency treatment).
So, it’s important to calculate after-surgery costs. The good news, there are packages of gastric sleeve surgery with one bundled price that also include costs of complications.
So ask your surgeons first before making deal! They should be willing to work with you to meet your financial requirement most. To avoid surprise down the road, it’s recommended to always ask and negotiate up-front price that covers all services!
If there are certain services not included in the up-front price (e.g. surgical assistant fees, pre-operative testing, and radiologist fees), ask them about an estimate of what these additional services will cost!
Low surgical cost with medical travel option
Also called medical tourism, medical travel option is sometimes a good way to get affordable weight loss surgery without ignoring your concern of getting top-notch medical care. The best bet (easy to get to from Florida) is Mexico.
The operation cost in Mexico for gastric sleeve surgery is only about $5,000 (more affordable than in US and Canada). But it’s also important to make sure everything is safe.
Is gastric sleeve surgery in Mexico safe? With proper precautions, it can be one of your safe choices. Here are a few precautions you need to understand.
- Be informed to any information about the quality and safety standards of weight loss surgery in Mexico! In fact, many Americans have been travelling to this country to look for more affordable surgery, and nowadays they keep coming back.
- Do your own research to find the best one. Ask anyone in your local area whose been there – do as much planning as possible to increase your chance of having successful medical travel surgery.
- If possible, choose Mexico hospitals that are qualified with JCI certification. JCI, the Joint Commission International, is an international division from the Joint Commission (the respected hospital accreditation agency in the US).
- Since there are only a few hospitals with JCI certification in Mexico, hospitals with CSG certification (a reputable accreditation from the Mexican Ministry of Health) are also good idea.
How about non-accredited options? A few great, reputable hospitals in Mexico are not accredited for various reasons. However, if you decide to use one of them, make sure the practice is reputable and qualified for gastric sleeve surgery!