What affects the cost of gastric sleeve surgery

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What affects the cost of gastric sleeve surgery

There is no single price for a gastric sleeve, because the total is built from several separate charges: the surgeon, the hospital, anesthesia, tests before surgery and care afterward. What you pay yourself depends mostly on whether your plan covers the operation, on your deductible and network, and on whether anything is added to the operation. This page explains the drivers. For figures that apply to you, ask the office.

The separate parts of a sleeve bill

Part	What it covers	What makes it larger or smaller
Surgeon	The operation and, usually, a set period of follow-up visits	Whether it is a first operation or a revision; whether another procedure is done at the same time
Hospital (facility)	Operating room, staff, staplers and other supplies, recovery, the room	Operating time, the equipment used, and how long you stay
Anesthesia	The anesthesia clinician and medicines	Length of the operation; your other health conditions
Pathology and lab	Examination of the removed part of the stomach; blood tests	Which tests are ordered
Before surgery	Consultations, blood work, heart and sleep testing, endoscopy if needed, nutrition and behavioral health evaluations	Your health history and what your insurer requires
After surgery	Follow-up visits, blood tests, vitamins and protein supplements	How long follow-up is included before visits are billed separately

Vitamins are easy to overlook. They are needed for life after a sleeve and are usually bought over the counter, so they are a continuing cost outside any surgical quote. See vitamins and lab tests after a gastric sleeve.

How insurance changes what you pay

If your plan covers bariatric surgery and approves the request, your share is set by the plan's design, not by the surgeon: the deductible, coinsurance or copays, and the yearly out-of-pocket limit. Whether the surgeon, the hospital and the anesthesia group are each in your network matters as well. Ask about all three.

Timing can matter. Surgery late in a plan year, after the deductible has been met by other care, can leave you owing less than the same surgery in January.

Whether the plan covers the operation at all is a separate question. Aetna's policy states that some of its plans entirely exclude surgical treatment of obesity, and Cigna's says coverage varies across plans. Our page on insurance requirements for a gastric sleeve explains how those decisions are made. The practice works with PPO and HMO plans that allow care with Dr. Davtyan. Ask us whether we can see patients on your plan.

Things that can add to the operation

Hiatal hernia repair. A hiatal hernia (part of the stomach sliding up through the diaphragm) is sometimes repaired during a sleeve. Aetna's policy treats a repair done during bariatric surgery as incidental and not separately reimbursable, which shows how one insurer handles the billing. See hiatal hernia and the gastric sleeve.
Endoscopy. Cigna's policy treats an endoscopy done during the operation to confirm a surgical connection or establish landmarks as part of the procedure and not separately reimbursable. Ask how an endoscopy on a different day would be billed.
Revision surgery. Operating on a stomach that has had surgery before generally takes longer and is billed with different codes.
A longer stay or a return to hospital. A complication can add hospital days, tests or another procedure. Ask how these are handled in a self-pay arrangement.

If you are paying yourself

Federal rules give people who are not using health insurance a way to see expected charges in advance, called a Good Faith Estimate. According to CMS, a provider usually must give one when you ask or when you schedule care at least 3 business days ahead. It must include an itemized list with expected charges for the items and services related to your care. If you schedule 3 to 9 business days ahead, you should get it within 1 business day; at 10 or more business days ahead, within 3 business days. For a scheduled surgery, CMS suggests requesting one estimate from the surgeon and one from the hospital.

CMS also describes a dispute process for self-pay patients whose final bill from a provider is well above that provider's estimate. It sets a dollar threshold for the difference and requires the bill to be dated within the last 120 calendar days, and you need the estimate itself to use the process. Keep every estimate you are given.

When comparing self-pay quotes, compare what is inside them: surgeon, hospital and anesthesia; pre-surgery testing; how many months of follow-up; and what happens financially if you need to go back to the operating room. Ask the office how self-pay quotes are written and what they include. Also ask the office whether financing is available.

Taxes and health accounts

IRS Publication 502 says you can include in medical expenses amounts paid for legal operations that are not cosmetic surgery, and amounts paid to lose weight when that is treatment for a specific disease diagnosed by a physician; it names obesity as an example. Whether you benefit depends on your own tax situation, so ask a tax professional. Health savings and flexible spending accounts have their own rules and paperwork; keep itemized receipts.

Questions to ask before you agree

Is this estimate itemized, and does it include the surgeon, hospital, anesthesia and pathology?
Which pre-surgery tests are included, and which will be billed by someone else?
How many follow-up visits are included, and for how long?
Is every party in my network, and has prior authorization been approved in writing?
If a hiatal hernia is found and repaired, does the estimate change?
If I need to be readmitted, who bills me and how?

Frequently asked questions

Why do two people having the same sleeve surgery pay different amounts?

Because the amount a patient owes is mostly set by their own plan. Two people with the same operation can have different deductibles, different coinsurance, different networks and different amounts already paid toward their yearly limit. For self-pay patients, the difference usually comes from what each quote includes and where the surgery is performed.

Does the hospital send a separate bill from the surgeon?

Often, yes. The surgeon, the hospital and the anesthesia group are usually separate businesses that bill separately, and a pathology or laboratory bill may follow. Some self-pay arrangements combine them into one figure. Ask which approach applies to you, and ask for it in writing, so that a later envelope does not come as a surprise.

Are follow-up visits after a sleeve included in the surgery cost?

Usually for a set period after the operation, and then visits are billed like any other office visit. The length of that period varies, and blood tests are often billed by the laboratory. Ask what is included before you agree. Long-term follow-up is part of the plan, as described in the gastric sleeve follow-up schedule.

Is the first consultation charged?

The first consultation with Dr. Davtyan is complimentary. Tests or evaluations ordered after that visit, such as blood work, a sleep study or a nutrition evaluation, are separate services, and they may be billed to your insurance or to you depending on your plan. Ask at the visit which ones you are likely to need.

Talk with Dr. Davtyan in Rancho Cucamonga

Dr. David G. Davtyan, MD, FACS, FICS, FASMBS, is a bariatric surgeon. The first consultation is complimentary, and it is a good time to ask about costs before you commit to anything. Call Davtyan Medical Weight Loss & Wellness at 909-355-2525 or use the contact page; the office is at 8330 Red Oak Street, Suite 201, Rancho Cucamonga, CA 91730. More topics are in the Rancho Cucamonga gastric sleeve guide.

What affects the cost of gastric sleeve surgery

What affects the cost of gastric sleeve surgery

The separate parts of a sleeve bill

How insurance changes what you pay

Things that can add to the operation

If you are paying yourself

Taxes and health accounts

Questions to ask before you agree

Frequently asked questions

Why do two people having the same sleeve surgery pay different amounts?

Does the hospital send a separate bill from the surgeon?

Are follow-up visits after a sleeve included in the surgery cost?

Is the first consultation charged?

Talk with Dr. Davtyan in Rancho Cucamonga

Sources

More in the Gastric Sleeve in Rancho Cucamonga guide

Understanding the sleeve

Weighing your options

Getting care in Rancho Cucamonga

Adult BMI Calculator

Beverly Hills

Glendale

Rancho Cucamonga

South Coast Lap-Band

Marina Del Rey Hospital

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