Affording Weight-Loss Surgery

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Affording 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.

How to Get the Help You Need

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 insurance plan representative.

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.

Until recently, 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.

Working with a Surgeon

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 of Bariatric Surgery (ASBS). Members of ASBS 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.

Financing a Healthier Life

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 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.

Better Quality of Life

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.

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