Medicare Cover for Bariatric Surgery – How to fund your Bariatric Weight Loss Surgery
Find out by downloading our Guide to Medicare and Health Insurance for Weightloss Surgery
Weightloss Guide Download
With the epidemic of obesity in Australia, many people are turning to weight loss surgery when dieting and exercise don’t achieve the result they want. Furthermore, many overweight patients are asking if Medicare will pay for their post-bariatric surgery. Weight loss surgery in Australia not only requires your BMI to be at least 30 but it also includes specific procedures. For example, gastric sleeve, gastric bypass, lap band, and gastric balloon.
Will Medicare cover the cost of my Bariatric Surgery?
Do I qualify for weight loss or obesity surgery?
Qualifying for Bariatric Surgery
If you are looking to undertake gastric sleeve, lap band or gastric bypass surgery, Medicare item numbers require that your BMI (body mass index) be at 30+. Similarly, for a gastric balloon, you need to be at 27+ BMI. However, if you have a BMI between 30 to 39.9, Medicare requires you to demonstrate other, certain health problems to qualify for coverage. Although a BMI of 40 or higher, will qualify you for aid with or without other related health issues.
Health Problem Criteria at a BMI of 30 or Higher:
Firstly, poorly controlled type 2 diabetes.
Secondly, high risk of cardiovascular disease.
Health Problem Criteria at a BMI of 35 to 39.9
Patients usually have one or more obesity-related health problems including:
Gall bladder disease
PCOS and Infertility
Sleep apnea and also Sleep deprivation
Non-alcoholic fatty liver disease
Venous stasis disease
Health Problem Criteria at a BMI of 40 or Higher
No health problems required to qualify for surgery
However, if your BMI qualifies you for cover, your next step is to decide which procedures are a fit for you. As a result, a specialist bariatric surgeon can help you decide what is best for your body and health.
Download Our Weightloss Surgery Guide
Weightloss Guide Download
Ideal Patients for Obesity Surgery
Ideal patients who Qualify for Bariatric Surgery include people that are;
Between 18-75 years old
At least 36 kg overweight
At a BMI of 30 or more
Able to demonstrate a history of failed weight loss attempts
Thoroughly understand that weight loss procedures are just a surgical tool and that long term success will also require significant diet and lifestyle changes.
Four Most Common Weight Loss Procedures for Obese patients
Below lists the four most common types of bariatric or weight loss surgery in Australia:
And finally, Gastric Balloon, this is a newer “in-between” option that is more aggressive than diet and exercise however, it is less aggressive than other bariatric procedures.
Cost of Weight Loss Surgery in Australia
There is no one price for the procedure, as each surgeon has different experience and there are many factors that influence the cost of your procedure. For example:
Whether you are insured or uninsured
Consultation fees for your surgeon and GP
The type of procedure being performed
Bariatric Surgeon fees
Surgical assistant fees (if required)
Hospital fees and length of stay
As well as, medications you need post-surgery
If you want a more detailed quote, book an appointment today with a qualified bariatric surgeon. Be sure to always ask if there are any added charges or additional procedures required during or after your surgery.
Will Medicare pay for my Bariatric Surgery?
In Australia, Medicare will provide some reimbursement for weight loss procedures. However, as of November 1, 2018 update, some of the Medicare Benefits Scheme changed. These changes may impact your ability to receive a rebate for surgery. Weight loss surgery is not fully covered under Medicare, in other words, you will still incur some out-of-pocket expenses. However, most weight loss surgery is performed under Private Health Insurance and is accessible to most Australians.
Medicare Item Numbers for Weight Loss Surgery
Popular Medicare Item Numbers used for Weight Loss Surgery in Australia include
31369 for Lap Band Surgery (Item 31584 for Lap-Band Removal)
Medicare Item Numbers 31569 to 31581 and item 20791 provide for surgical treatment of clinically severe obesity and the anaesthesia service required (or similar). If you would like more information regarding criteria for Medicare Item Numbers you can also visit the MBS Website
Will Private Insurance cover my Weightloss Surgery? – Bariatric Surgery & Private Health Insurance
Some private insurance services will also provide coverage for bariatric surgery. However, you will still have out of pocket fees over what your insurance company will cover. Moreover, since obesity is considered a pre-existing condition, you will likely have to wait 12 months between joining a health fund and getting approved for surgery. In fact, many surgeons will not perform any bariatric surgery (other than lap band) if you do not have private insurance. Consult with a bariatric surgeon for further help in understanding the total costs and how insurance will apply.
Consider taking out Private Health Insurance
Many surgeons will NOT take uninsured bariatric patients due to the real risk of having an extended and expensive stay in Hospital post surgery due to a complication. You may be better to consider taking out private health insurance and serving the 12 months waiting period. In future, you may also need surgery for excess skin removal after losing a lot of weight. Many post-bariatric surgery patients report having saved around $10k per year on their food bills – due to eating smaller portions and more home cooked meals. (less takeaway). This saving could help pay for future surgery needed.
Post Weight Loss Surgery – Reducing the Excess Loose Skin – Download Our Excess Skin Reduction Guide
Weightloss Guide Download
Please visit www.newbodyspecialists.com.au for a directory of Australian Bariatric Surgeons and an overview of different types of bariatric surgery.
Stay informed about the latest bariatric news and obesity treatment, tips, surgery options and more.
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