I lucked out, though, because my insurance — Health Alliance, purchased through the Illinois Marketplace — did cover the surgery. I had surgery in St. Louis, Mo., and I learned at my orientation session with my second program (I was in a different program for two years; more on that next week in a big post in honor of my surgiversary) that in Missouri, Marketplace plans are not required to cover bariatric surgery, so very few do. But in Illinois, they have to cover it.
Of course, the amount each person will ultimately have to pay will vary based on a lot of factors — the specifics of their insurance plan, the program they’re in, what kind of surgery they have, where the surgery is conducted, and so on. However, I thought it might be helpful to share how my costs broke down.
Some context: I had Roux-en-Y gastric bypass surgery at Barnes-Jewish Hospital in St. Louis, Mo., through the Washington University WLS program. My surgery was on Feb. 15, 2018, and I was in the hospital until Feb. 17. At the time, I had a deductible of $1,000 on the Health Alliance POS 6300 Elite Silver CS plan. In addition to my primary surgeon (Dr. Arghavan Salles), another (Dr. Christopher Eagon) assisted.
- Laparoscopic gastric bypass w/ Roux-en-Y: Billed = $5,100, My cost = $145.97 (I believe this is for Dr. Salles)
- Laparoscopic gastric bypass w/ Roux-en-Y: Billed = $2,550, My cost = $29.19 (I believe this is for Dr. Eagon)
- Anesthesia gastric restrictive for morbid obesity: Billed = $3,360.00, My cost — $1,013.22 (includes $1,000 deductible)
- Anesthesia gastric restrictive for morbid obesity: Billed = $3,360.00, My cost — $63.22 (not sure why there are two anesthesia charges)
- Contrast X-ray — Esophagus: Billed = $123, My cost =$0
The claim for the hospital stay broke down like so (each item is listed exactly as it appeared):
- Room-board/semi: $2,210.00
- Pharmacy: $439.90
- Med-sur supplies: $10,306.95
- Sterile supply: $472.50
- Laboratory OR (Lab): $35.00
- Lab/Chemistry: $244.00
- Lab/Hematology: $81.00
- DX X-ray: $448.00
- OR services: $23,365.00
- Anesthesia: $8,336.00
- Occup Therp/Eval: $259.00
- Drugs/detail code: $698.15
- Drugs/self-admin: $8.00
- Recovery room: $2,460.00
- Educ/training: $110.00
- O.R. procedures for obesity W/O.CC/MCC: $0.00
- TOTAL billed = $49,473.50, My cost = $100.00
All told, I only had to pay $1,351.60 out of $63,966.50, or roughly 2.11 percent of the overall cost of surgery, and my portion included the $1,000 deductible. Without that, I would have only been responsible for $351.60, or 0.55 percent of the overall cost.
However, that does not include anything pre-op. My pre-op period was much longer than most (nearly three years from my very first consultation until my surgery date), though, and I long ago lost track of how much I paid for lab work and CT scans and X-rays and co-pays for seeing doctors and physical therapists and social workers and so on. I’ve been with Health Alliance for the whole process, but on a variety of different plans, each with different copays.
I’m still, slowly, paying off my portion of the cost, but I’m grateful because I know I’m lucky. My mom wants to have (and, given some of her health issues, would greatly benefit from) bariatric surgery as well, but her insurance refuses to cover it — and she’s a nurse at a hospital. It’s completely astounding to me that a hospital’s insurance company won’t cover bariatric surgery, even if it’s deemed medically necessary.