Health Insurance For Weight Loss Surgery
Compare quotes for health insurance which include cover for weight loss surgery here through Savvy.
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Having weight loss surgery is not a decision to be taken lightly, and neither is choosing health insurance which may help cover some of the costs of this type of treatment. Whether you’re looking to have a sleeve gastrectomy or lap band surgery, it’s very important to compare health policies carefully if you are considering weight loss surgery to see what your best options for cover may be.
You can find and compare health insurance policies which include weight loss surgery right here through Savvy. We help make the process simple by enabling you to compare a range of quotes instantly and free of charge. Just answer a few questions about yourself and the type of insurance you’re after and you could be looking at a range of health cover policies side-by-side from a panel of some of Australia’s leading insurers.
Do private health insurance policies cover weight loss surgery?
In Australia, the Government regulates the hospital cover which must be offered by the four tiers of hospital cover: basic, bronze, silver and gold. Under these tiers of treatment, only the most expensive option, gold cover, must reimburse costs for weight loss surgery. Therefore, to be covered for weight loss surgery, you’ll likely need to buy a gold-tier hospital cover policy.
A gold-tier hospital policy may cover some of the following aspects of your hospital stay for weight loss surgery and subsequent care:
- Private hospital accommodation fees
- Theatre fees
- Doctor, bariatric surgeon and anaesthetists' fees
- Diagnostic tests conducted in a hospital setting, such as x-rays, CT and MRI scans
- Medications provided whilst you’re an inpatient
- Fees for post-op visits by psychologists, dieticians or lifestyle advisors whilst you’re still an in-patient in hospital
However, there may still be some out-of-pocket expenses and associated procedures for which your gold hospital cover health insurance may not cover you. For example, you may still have to pay a portion of the surgeon’s and anaesthetist’s fees if they charge over the Medicare Benefit Schedule (MBS) fee for that service. This is referred to as a ‘gap’ payment. Other areas which may not be covered include:
- Hospital cover excess – an amount you have to pay each time you make a claim on your health insurance policy. This can range from zero to $750, depending on the policy you decide to buy
- Co-payment fees – a co-payment fee is an amount you are required to pay with some hospital cover policies for each day you remain in hospital. This amount can vary but is usually around $100 a day, capped at $700
- Skin reduction surgery – this is surgery (often performed after the initial weight-loss surgery) which aims to remove excess skin
- Muscle tone surgery – sometimes additional surgery is also required (once a considerable amount of weight has been lost) to tighten up loose muscles to regain muscle control
What types of weight loss procedures are available in Australia?
There are three types of weight loss surgeries which are routinely performed in Australia and can be covered by appropriate private hospital insurance. They are:
- Sleeve gastrectomy (also known as gastric sleeve surgery): this type of surgery removes between 70% and 80% of the stomach, changing it from a large bag to a small tube through which food passes. It's a type of surgery which offers lifelong compulsory food volume control, as the patient is physically unable to eat more than the small remaining tube can hold at one time, and isn’t reversible.
- Gastric banding (also known as lap band surgery): in this procedure, a silicone band is used to tie off a section of the stomach, making it much smaller. The remainder of the stomach remains inside the body, making this type of surgery reversible. It is considered a less radical procedure than gastric sleeve surgery, as the stomach remains connected and viable. The volume of food which can be consumed is limited by the reduced-size stomach pouch.
- Gastric bypass surgery (also known as Roux-en-Y gastric bypass): this involves making a small pouch out of the top part of the stomach, which is then attached to a loop of the small bowel. The remainder of the stomach is disconnected from the intestines but is left inside the body. A fixed ring can be placed to form the small stomach pouch, which can sometimes be removed or replaced with a different-sized ring in further operations if required. This surgery is most often performed on very obese individuals with a BMI of over 50, Type 2 diabetics and those who suffer from gastric reflux.
Is weight loss surgery covered by Medicare?
The cost of weight loss surgery can be covered by appropriate private health insurance and/or Medicare, but there are strict criteria which apply to be eligible for this type of treatment through the private and public health systems. It’s necessary to require weight loss surgery for defined medical reasons, rather than lifestyle or cosmetic reasons.
It is important to consider whether you may be eligible for weight loss surgery covered by Medicare when considering whether to have it using private health insurance versus through Medicare as a public patient.
The criteria that apply to be eligible for weight loss surgery under appropriate private health insurance and/or Medicare are:
- You must have a BMI (body mass index) of 35 or more
- There must be medical documentation that you’ve been severely overweight for at least five years
- You must have a co-morbidity which results in a major health risk, such as sleep apnoea, diabetes, heart disease, osteoarthritis or high blood pressure
- There must be evidence that you have unsuccessfully tried other weight loss methods and programs under medical supervision
- There must be no other cause for obesity such as adrenal, thyroid or pituitary gland issues
- You must be assessed by a team of health care professionals and deemed to be an eligible candidate before approval for this surgery can be given
If you do fulfil the above criteria and gain approval for weight loss surgery, Medicare will fund some of the costs of the surgery, but there may still be substantial out-of-pocket costs even if you’re treated in a public hospital. Each of the three weight loss surgeries listed above can qualify for Medicare subsidies.
How much does weight loss surgery cost in Australia?
The cost of your weight loss surgery will directly depend on which procedure you have done, as well as:
- Whether you’ve been approved for Medicare-funded bariatric surgery
- Whether you have your surgery as a public or private patient
- The complexity of your surgery and how many surgeons or bariatric specialists are required to perform the operation
- The number and type of other health issues you may have (such as high blood pressure or diabetes)
- The number of additional support services you may require following your surgery
There is no standard cost for weight loss surgery. However, the indicative average costs for a person who does not have private health insurance, correct as of February 2023, are:
- Gastric sleeve surgery: upwards of $20,000
- Gastric banding: between $12,000 and $18,000
- Gastric bypass surgery: between $15,000 and $20,000
If you have the best gold-tier hospital cover available for weight loss surgery, a large proportion of these costs may be covered by your health insurance. However, you could still expect to pay between $2,000 and $6,000 in out-of-pocket expenses. Medicare may contribute a small amount towards the cost of your surgery if you’re an approved patient, with the MBS contribution ranging from around $1,000 to $1,500 for weight loss procedures. This will depend on the MBS codes for the procedure you have done.
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