The Cost of Gastric Sleeve Surgery
Over all of the United States, as of 2015, 51.4 million surgeries are done every year. Of those surgeries, only 179,000 surgeries every year are bariatric (weight loss) surgeries. Costs of surgery, of course, differ by state and the competition in that state.
According to Obesity Coverage, $16,800 is the average cost of gastric sleeve surgery across the United States. However, while at first it seems much more practical to go across state for surgery, it might become more expensive in the long run.
How Do Gastric Sleeve Surgery Costs Compare to Gastric Bypass Surgery?
Gastric bypass surgery involves stapling the stomach, leaving a walnut-sized portion, and then attaching the stomach to a lower part of the small intestine. This causes less calorie absorption, and the smaller stomach means you get more full, sooner.
Gastric sleeve surgery was initially considered a safety measure for gastric bypass surgery patients. Because of this, it is usually a cheaper option than gastric bypass surgery. Gastric bypass surgery is $24,000, compared to the almost $17,000 of gastric sleeve surgery.
Why is Gastric Sleeve Surgery in Some States so Much More Expensive than in Others?
It usually depends on the demand for weight loss surgery in the specific state. The higher the demand, the more surgeons will be offering that kind of surgical procedure. The more surgeons there are, the more competition there will be among surgeons. The higher the competition, the lower the prices go.
Looking at the states with the cheapest gastric sleeve surgeries, it is evident they tend to correlate with states with the highest obesity rates. Oklahoma is the cheapest state to get a surgery in ($9,795). It is also 6th in the most obese states in the United States, with a 33.0% obesity rate. Georgia, cheapest after Oklahoma ($11,220), ranks 19th with a 30.5% obesity rate.
Following is a list of the states according to price, with their national obesity ranking and if they have mandatory coverage under Obamacare.
|Oklahoma||$ 9,795||6th – 33.0%||Mandatory coverage by Obamacare|
|Georgia||$ 11,220||19th – 30.5%||—|
|Nebraska||$ 11,760||21st – 30.2%||—|
|Arkansas||$ 11,934||1st – 35.9%||—|
|Kentucky||$ 12,610||12th – 31.6%||—|
|Kansas||$13,390||13th – 31.3%||—|
|Texas||$13,770||11th – 31.9%||—|
|Indiana||$ 13, 905||7th – 32.7%||—|
|New Jersey||$14,065||41st – 26.9%||Mandatory coverage by Obamacare|
|Nevada||$ 14,085||35th – 27.7%||Mandatory coverage by Obamacare|
|Florida||$ 14,112||44th – 26.2%||—|
|Utah||$ 14,222||45th – 25.7%||—|
|Mississippi||$ 14,280||3rd – 35.5%||—|
|North Carolina||$ 14,685||25th – 29.7%||Mandatory coverage by Obamacare|
|Colorado||$ 14,700||51st – 21.3%||—|
|Alabama||$ 14,935||5th – 33.5%||—|
|California||$ 15,130||47th – 24.7%||Mandatory coverage by Obamacare|
|Louisiana||$ 15,402||4th – 34.9%||—|
|Washington DC||$ 16,219||50th – 21.7%||—|
|Ohio||$ 16,415||8th – 32.6%||—|
|Tennessee||$ 16, 415||14th – 31.2%||—|
|South Carolina||$ 16,660||10th – 32.1%||—|
|Missouri||$ 16,668||20th – 30.2%||—|
|Wisconsin||$ 17,340||15th – 31.1%||—|
|Oregon||$ 17,800||34th – 27.9%||—|
|Virginia||$ 18,360||31st – 28.5%||—|
|Michigan||$ 18,430||18th – 30.7%||Mandatory coverage by Obamacare|
|West Virginia||$ 18,430||2nd – 35.7%||Mandatory coverage by Obamacare|
|Montana||$ 18, 620||42nd – 26.4%||—|
|Maine||$ 18,624||33rd – 28.2%||Mandatory coverage by Obamacare|
|North Dakota||$19,580||9th – 32.2%||Mandatory coverage by Obamacare|
|New Mexico||$ 19,580||32nd – 28.4%||Mandatory coverage by Obamacare|
|South Dakota||$ 19,580||23rd – 29.8%||Mandatory coverage by Obamacare|
|Pennsylvania||$ 20,370||22nd – 29.8%||—|
|Arizona||$ 20,470||29th – 28.9%||Mandatory coverage by Obamacare|
|New York||$ 20,470||39th – 27.0%||Mandatory coverage by Obamacare|
|Minnesota||$ 20,580||36th – 27.6%||—|
|Wyoming||$ 22,250||27th – 29.5%||Mandatory coverage by Obamacare|
|Idaho||$ 24,920||31st – 28.9%||—|
|Massachusetts||$ 31,150||48th – 23.3%||Mandatory coverage by Obamacare|
The Affordable Care Act, also known as Obamacare, requires some states to make sure their insurance companies pay for weight loss surgery. This Act covers Family Plans, individual insurance plans, and Small Group plans (businesses with less than 50 employees). With more than 50 employees, the employer decides if the insurance plan will cover weight loss surgery.
As the table shows, there are still plenty of states not covered by Obamacare. However, the states on the more expensive side of the spectrum tend to have mandatory Obamacare coverage. Check with your surgeon, and ask if he or she can confirm your insurance coverage. Alternatively, you can ask your human resources department (HR), or check through your insurance policy summary.
Medicare also covers weight loss surgeries as long as a certain level of criteria is met. However, as long as the eligibility requirements are met, you can have lap band surgery, gastric bypass surgery, and gastric sleeve surgery.
When Can You Apply for Gastric Sleeve Surgery?
Insurance companies are the most likely to have strict requirements for those applying to receive gastric sleeve surgery. However, doctors also need to show that their procedure was necessary for the patient. If you are opting for other financial aid, such as loans or special health savings accounts, you usually still need to prove eligibility for surgery.
First, you need a physician-confirmed body mass index (BMI) of 40, which is classified as morbid obesity (BMI 40-44.9). However, there are some cases when there is already an obesity-related condition (a co-morbidity) that causes complications. You will probably need surgery earlier.
In those cases, you can apply at BMI 35 (severe obesity), as long as you have certain conditions (in the next section). With Medicare, you need to have a co-morbidity to be eligible for insurance coverage. You also need to prove you were obese for at least 5 years.
Next, you need to prove, through medical supervision, that you have been on a physician-recommended diet for 3 to 7 months. It depends on your insurance provider and on your physician. Your primary physician needs to give you a medical clearance letter for surgery, which you will submit wherever you are getting funding from.
You will also need clearance and an evaluation from a Registered Dietitian, and a history of other weight-loss treatments. This medical history includes all of the health problems you are facing that are obesity-related, any extra difficulties you are going through as a result of your condition, and any treatment you have gone through. If you have done any other weight-loss treatments before, you need to provide the reason for discontinuing them.
Under Medicare, you also need a psychological evaluation, and several other tests that rule out other causes for obesity. You will need your thyroid, adrenal, and pituitary tests to all register as normal. You also need to prove you have tried, and failed, at least one other weight loss program.
Conditions Which Allow Early Surgery (BMI = 35)
Clinically Significant Obstructive Sleep Apnea
Sleep apnea is a condition in which the patient simply stops breathing while he or she is asleep. Obstructive sleep apnea usually happens with obese patients. The weight of fat on the airway causes a throat tissue collapse. The airway becomes fully blocked, and the patient stops breathing until he or she wakes up from loss of air, or shifts position.
Coronary Heart Disease
The coronary arteries are the arteries which carry oxygen-rich blood to the heart. When there is a buildup of fat along the artery walls, less and less blood, and therefore less and less oxygen, reach the heart. If the arteries become blocked, a heart attack can occur. Breakage of the artery would lead to a blood clot.
Patients with medical hypertension have uncontrollable blood pressures, even with regular treatment. If, after more than 3 visits and consultations the blood pressure remains uncontrollable, it becomes resistant hypertension. It can be caused by excess of fat and stimulants, and even by sleep apnea and diabetes.
Your body converts food into blood sugar, or glucose, to burn as energy. Insulin channels that glucose into the cells when you need it, and regulates the levels of sugar in the blood for your safety. With too much sugar to deal with, in obese patients, the insulin can no longer cope even when more is produced. Because of that, sugar can either drop or spike dangerously.
Why Not Just Go Out of State?
Before and after gastric sleeve surgery, you will need to have regular checkups, consultations, and tests. Having your primary surgeon in another state may cause more costs than you plan on. Your pre-op weight loss program will have corresponding consultation fees, as will your physician-guided diet. Your post-op check-ups and consultations with your surgeon will provide even more complications.