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Compare Health Insurance for Weight-Loss Surgery

Megan Fraser Fact Checked Updated: 30 June 2023
Types of Health Insurance

There are many types of weight loss surgery out there, but if you have an obesity-related health problem like Type 2 diabetes or high blood pressure that’s causing your excess pounds and unhealthy wellbeing, then bariatric may be the perfect solution for you.

Bariatric surgery is a type of surgery that helps people to lose weight by restricting the amount of food they can eat or by limiting the absorption of nutrients from food. Gastric bypass surgery and gastric sleeve surgery are two common types of bariatric surgery. Both procedures involve making changes to the stomach and small intestine. Read on to discover more about weight loss surgeries in Australia.

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What are the most common types of weight-loss surgeries in Australia?

  • Bariatric Surgery: Bariatric surgery refers to surgery that directly affects your stomach and how it digests food. The idea is to make your stomach feel smaller so that you feel fuller for longer after small meals. As a result, you might end up eating less food, which means you would absorb fewer calories.
  • Gastric banding ‘lap banding’: A lap band surgery involves an adjustable ring that is inserted around the top part of the stomach, effectively creating a tiny pouch. This then causes food to stay in the top part of the stomach for longer, creating a sensation of being full.
  • Gastric sleeve surgery: A huge part of the stomach is removed during gastric sleeve surgery, reducing the stomach to a sleeve-like shape. The volume of the stomach is reduced by 80%, and therefore only small amounts of food can be consumed.
  • Gastric bypass surgery: Gastric bypass surgery is the stapling of the stomach to form a little stomach pouch. A section of the small intestine is removed, and the bag is connected directly to the small intestine. Essentially when you eat, the food now bypasses most of the stomach. Consequently, you would now consume fewer calories – which could lead to weight loss.
  • Gastric balloon: A gastric balloon procedure is non-surgical and temporary. A lightweight gastric balloon is inserted into the stomach. It then sits in the stomach for six months to help the stomach feel fuller quicker, and in doing so, the patient may eat less.
  • Duodenal switch: The duodenal switch is a bariatric surgery that combines the benefits of sleeve gastrectomy with an intestinal bypass. It has been proven to help those suffering from Type 2 diabetes. The surgeon removes a large portion of your stomach and then attaches the remaining section to what’s left. This has an effect as dramatic on calorie absorption, and nutrient intake as a gastric bypass would have done.
  • Liposuction: Liposuction is a surgical procedure that uses the power of suction to remove fat from specific areas such as your abdomen, hips and thighs. The process also shapes these regions by redefining them with an aesthetic edge for perfecting appearance so you can live comfortably without worrying about gaining weight.

How much does weight loss surgery cost without insurance?

Weight loss surgery is not cheap. The cost of a procedure can range anywhere from $10,000 to over $20 000 if you don’t have insurance. It’s important to investigate all your options before going through with this big decision.

Type of surgeryCost without private insuranceCost with private insurance
Gastric band surgery (Lap band)$10 000 – $15 000*$3 000 – $8 000*
Gastric sleeve surgery$18 000 – $24 000*$4 000 – $7 000*
Gastric bypass surgery$16 000 – $18 000*$4 000 – $8 000*
Gastric balloon cost$5825Insurance typically will not cover this procedure. They may cover the gastroscopy.

Source: North Eastern Weight Loss Surgery(June 2023)

Factors that determine the cost of weight-loss surgery

There are many aspects of medical care that go into weight-loss surgery. The final cost for each patient may vary depending on a number of factors. It’s therefore recommended that you review and compare the various services and costs of each that go into calculating the final price to ensure you’re receiving value for money. Below is a list of the factors that make up the total amount of weight-loss surgery in Australia:

Does health insurance cover weight-loss surgery?

Generally, Gold hospital policies from private health funds might cover some of the cost of your in-hospital weight-loss surgery. Depending on your insurer and level of cover, private health funds could cover more than 60% of your weight-loss surgery.
Take note: To claim a benefit for weight-loss surgery, you’ll likely need to serve a waiting period of 12 months because obesity is usually considered a pre-existing condition.

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Private health insurance for weight-loss surgery

Private health insurance is often a great option for those looking to weight loss surgery. With the right kind of cover, you can find yourself with much lower premiums and out-of-network benefits that will help cut down on costs.

Private health insurance often covers the costs associated with bariatric surgery if patients have adequate coverages and meet certain criteria. This includes having gold tier hospital policies or higher Plus policy types that provide coverage in general rather than just emergency services alone.

bariatric surgery 01

Does Medicare cover weight-loss surgery?

Medicare will pay 75% of the Medicare Benefits Schedule for weight-loss treatments performed in hospitals. However, you must have a practitioner who has approved and diagnosed you with clinically severe obesity before you are eligible to receive these funds from their insurer.
Clinically severe obesity is a medical condition where your body mass index (BMI) exceeds 40 or 35 when you have heart disease and diabetes. It’s important to know there may be long waiting periods before undergoing bariatric surgery.

Out-of-pocket costs to expect

The 75% Medicare rebate on weight loss surgery is usually not enough to cover the entire cost. You will have to pay out of pocket for any additional expenses you incur during or after your procedure.

Your out-of-pocket costs may look something like this:

Health insurance for weight management versus weight-loss surgery

Weight management – The insurers that offer Top Extras policies often have a weight management program. This benefit is usually listed under their “healthy lifestyle programs” and can include discounts on gym memberships or dietary assistance for losing extra pounds

Weight loss surgery – Gold Hospital insurance is the best way to protect yourself from high costs. With a policy that includes weight-loss surgery, you could expect to pay anywhere between $2,800 and 7 thousand dollars for any type of operation – it just depends on your surgeon and where in Australia you live!

Are there other options for funding weight loss surgery?

The Department of Human Services (DHS) may release some or all of your superannuation funds on what they call “specified compassionate grounds” for a medical treatment that Treats an illness that is life-threatening, relieves acute pain, and symptomatically Administers necessary opiates to treat chronic conditions. The Department of Health & Services may agree that an early release on your funds would help with payment for this necessary treatment!

Frequently Asked Questions and Answers

  • What is the waiting period for weight loss surgery?

    Generally, the waiting period for weight loss surgery is 12 months. Like any other surgery, private insurance providers will apply a waiting period before covering weight-loss surgeries for you. The purpose of these periods is to keep premiums low and ensure enough healthy people are in the pool so as not to create high costs for sick ones who need treatment immediately with an operation or medication regimen
  • How do I get approved for weight loss surgery?

    The title of this passage is To qualify for lap band surgery, patients must have a BMI of at least 40 (this typically translates to being overweight by 45.4 kilograms or more), but if you’re even just 11% above what’s considered healthy, then you can receive help. Patients are also required not only to meet one set of weight criteria – they need two very serious health conditions associated with obesity like type 2 diabetes and high cholesterol levels in order to attain access.
  • Who qualifies for gastric sleeve in Australia?

    If you are overweight or obese, then a sleeve gastrectomy may be right for your lifestyle. This surgery can help reduce weight by limiting food intake and modifying stomach size so that it’s less than two hundred fifty cubic centimetres in volume when measured vertically from top to bottom (this usually translates into an Order of Operations Obesity Score between 45+ kilograms). People who have some serious co-morbid health conditions along with them might also consider this procedure because they need more drastic measures than just dieting
  • Can weight loss surgery be covered by Medicare?

    Medicare covers bariatric surgery, and most private health insurers will cover it as well. Patients covered by Medicare are entitled to subsidise medical services for this procedure if they meet the criteria requirements, which include having a Body Mass Index (BMI) that exceeds 35 or being obese in order not to be denied coverage due to their weight condition!
  • What is the safest weight loss procedure?

    When it comes to weight loss surgery, there is no better option than The Vertical Sleeve Gastrectomy. As with any major medical procedure, especially those that affect your digestive system as this one does in some way or another, you need a surgeon who has experience performing these operations safely for years on end. The risks associated with long-term health problems from bariatric surgeries such as gallbladder removal can be significantly decreased by selecting someone skilled in their field. Hence, they know what steps must occur during every step of the process while also providing comprehensive aftercare plans, including monitoring patients closely post-surgery via X-rays if needed.
  • Who Cannot have bariatric surgery?

    To safely have surgery, you need a BMI of 35 or more with one or more obesity-related conditions. If your weight is healthy but not under 40, then it’s still important that the scale shows this as well.

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