Struggling with weight loss and considering gastric sleeve surgery? Understanding the costs and financial implications is a vital step. This in-depth guide breaks down the costs associated with gastric sleeve surgery in Australia, covering everything from the basic procedure price to what might be covered by Medicare and private health insurance.
SUMMARY
- Gastric sleeve surgery is covered by all gold-tier hospital policies.
- If you’re uninsured, gastric sleeve surgery can cost $20,000+.
- Gastric sleeve surgery comes with a 12-month waiting period when first signing up for health insurance, so it’s worth joining a health fund sooner than later
With obesity affecting around 12.5 million Australians, the road to weight loss can often feel overwhelming. If you’ve ever felt like you’ve exhausted all traditional weight loss avenues, you’re not alone. Many are turning to bariatric procedures, like gastric sleeve surgery, as an effective solution.
But the cost of weight loss surgeries can often stop people from accessing this life-changing procedure. While Medicare may cover some of the costs, it may not cover as much as private health insurance. Plus, if you choose to have gastric sleeve surgery in the public system, you’ll likely face extended waiting times.
If you’re serious about gastric sleeve surgery, stick around. We’re covering everything you need to know about the cost, who’s a candidate and what to expect after your surgery.
Cost of Gastric Sleeve Surgery in Australia
Bariatric surgery (AKA weight loss surgery) costs can add up quickly, and vary greatly. The price isn’t just for the procedure itself; it includes the surgeon’s fees, surgical assistant fees, an initial consultation, postoperative diet support, and various other hospital-related charges like radiology, pathology, anaesthesia, and assistance during the surgery.
Your final cost will depend on factors like the clinic or private hospital you choose and whether you have private health insurance.
There are three main bariatric surgeries offered in Australia, with the average costs varying:
- Sleeve gastrectomy/gastric sleeve surgery: anywhere between $12,500 and $20,000.
- Gastric band surgery: around $20,000.
- Gastric bypass surgery: generally, costs for this procedure range between $14,000 and $18,000 [16].
Does Medicare Cover Gastric Sleeve Surgery?
Yes, Medicare does cover some of the costs for weight loss surgeries, including gastric sleeve, but the reimbursement is minimal. Under the Medicare Benefits Schedule (MBS), you’ll find the following reimbursements:
- Sleeve gastrectomy: $673.65
- Gastric band surgery: $221.00
- Gastric bypass surgery: $828.90
Keep in mind, these amounts only cover a small part of the total cost, leaving significant out-of-pocket expenses in the thousands.
Gastric Sleeve Surgery Cost with Private Health Insurance Cover
Most private health funds in Australia often cover the cost of bariatric surgery that correspond with specific Medicare Benefits Schedule (MBS) Item Numbers. However, the coverage can vary depending on the insurance company and your specific plan.
Gold-Tier Hospital Policy
To get insurance coverage for bariatric surgery, you typically need a gold-tier hospital policy. This will typically cost you around $160 a month. There’s also a 12-month waiting period to get approval for surgery and to activate this cover.
Out-of-Pocket Costs
Even with Medicare and private health insurance, there might be some out-of-pocket expenses to be aware of, as they won’t cover all associated expenses.
Example: HCF’s Breakdown
If you join a premium health insurance plan like HCF
Hospital Premium Gold for $49.20 per week, they will cover most of the procedure, leaving you with a smaller gap. Here’s an example of how the costs might break down for gastric sleeve surgery:
- 82% is covered by HCF
- 14% is paid by Medicare
- Your out-of-pocket cost: 4% (for example, $600 if the total cost is $15,478)
Factors That Impact the Cost of Weight Loss Surgery
When considering weight loss surgery, understanding the potential costs can be complex. Several factors can influence the final bill, so here’s what you need to keep in mind:
- Principal Surgeon’s Fees: The expertise and experience of the surgeon can greatly influence the overall cost.
- Anaesthetist Fees: These professionals play a crucial role, and their fees form part of the total expense.
- Assistant Fees: Sometimes, additional medical staff are required during the procedure, and they aren’t free.
- Theatre Costs: The operating room itself has costs, including equipment and staffing.
- Excess Fee: Depending on your insurance, there might be an excess fee that you’ll have to cover.
- Type of Surgery: Different procedures come with varying price tags.
- Diagnostics Fees: Think lab tests and medical imaging; these extras can add up.
- Booking Fees: Some places may charge fees just for scheduling the surgery.
- Psychologist Fees: Emotional support and mental readiness are crucial, and professional guidance isn’t always covered by insurance.
- Length of Hospital Stay: Longer stays equal more cost, so this is an essential factor to consider.
- Dietitian Fees: Post-surgery, diet and exercise counselling are often necessary, and they can be expensive.
- Follow-up Surgeries: Sometimes, excess skin or loose muscles might need surgical attention, adding to the total cost.
What is Weight Loss Surgery?
In essence, weight loss surgery alters your digestive system to assist those with a high BMI (body mass index) in shedding kilos, especially when traditional methods like dieting, exercise, or medication haven’t been successful.
Moreover, bariatric surgery can be a life-changing surgical procedure for managing health conditions like diabetes, sleep apnea, and various heart disease risks.
The Three Common Weight Loss Procedures
In Australia, you’ll mainly encounter three types of weight loss surgeries
- Sleeve Gastrectomy (Gastric Sleeve Surgery): This surgery trims down your stomach to about one-third of its original size by removing a significant part and reshaping the remainder into a “sleeve”. With less room for food, your appetite shrinks. It’s a popular choice because it often leads to early weight loss.
- Gastric Band Surgery (Lap Band Surgery): This procedure involves placing an adjustable band around the top of the stomach, creating two sections. The smaller upper portion fills quickly, making you feel full sooner. Your doctor can modify the band by altering the saline solution inside it.
- Gastric Bypass Surgery: A more complex surgery, gastric bypass reduces stomach size and changes how the small intestine processes food. By creating a tiny stomach pouch and connecting it directly to the small intestine, the food bypasses most of your stomach [5], limiting your food intake.
Does it Hurt?
Does weight loss surgery hurt? The pain varies depending on the procedure, and common post-surgery experiences include incision pain, shoulder and neck discomfort, and side effects like nausea, vomiting, and body ache. Long-term risks could also include ulcers, hernias, anastomotic leaks, dumping syndrome, and more.
Is Weight Loss Surgery Right for You?
Weight loss surgery isn’t a one-size-fits-all solution. Your BMI and overall health play a vital role in determining if you’re a candidate.
In Australia, general guidelines are:
- BMI of 30+ with diabetes and cardiovascular risk: eligible for weight loss surgery.
- BMI of 35-39.9 with obesity-related health issues: potential candidate.
- BMI of 40+ without specific health conditions: also eligible.
Who’s Eligible for Weight Loss Surgery in Australia?
Weight loss surgery might sound like a one-stop solution for shedding those extra pounds, but it’s not a decision to take lightly. Not everyone qualifies, and the requirements can vary based on whether you’re going through Medicare or private health insurance.
Medicare Route
Medicare’s weight loss surgery criteria are a bit more stringent. Here’s what you’d need to tick off:
- BMI Check: Your body mass index must be at least 35.
- Previous Efforts: You’ll have to show that other weight loss methods haven’t worked for you.
- Psychological Evaluation: Expect to undergo a mental health check.
- Hospital Availability: Finding a public hospital offering this treatment in Australia can be a challenge, as only a few provide it.
Private Health Route
Private health insurers have a different process:
- Physician Consultation: A face-to-face meeting with a doctor will help determine if surgery is the right path for you.
- BMI Requirements: Some insurers might set specific BMI criteria, but generally, private health offers more flexibility and hospital choices.
What’s Your Coverage?
Weight Loss Surgery Coverage
If you’re thinking of going under the knife, you’ll need to get a gold-tier hospital policy for weight loss surgery insurance. But don’t wait too long! There’s typically a 12-month waiting period.
Weight Management Coverage
If surgery sounds too drastic, many extra policies offer coverage for weight management programs. These might include fitness classes, discounts on gym memberships, and access to nutritional consulting programs like WW (formerly Weight Watchers) and Jenny Craig.
The goal here is to promote healthy lifestyle habits. For some, it might even help avoid surgery altogether. Plus, the waiting periods for these programs are usually much shorter – about 2 months.
FAQs
Does Medicare cover weight loss surgery?
Certainly! Medicare does provide coverage for weight loss surgery in Australia, but it’s not a given. You’ll need to have a BMI of 35 or more and prove that the surgery is medically essential for you. A detailed in-person meeting with a physician is also part of the requirement, so expect a thorough evaluation before approval.
Can I get free weight loss surgery in Australia?
It’s possible, but not exactly simple. Medicare might cover your weight loss surgery if it’s judged to be a medical necessity. But keep in mind, this doesn’t mean everything will be free. There might still be some out-of-pocket costs, especially if any part of the treatment takes place in a private clinic.
How much is weight loss surgery without insurance?
In Australia, weight loss surgery can cost as much as $20,000 without insurance.
Are there waiting periods for weight loss surgery?
Yes – you will have to hold health insurance that covers weight loss surgery for 12 months before you are covered.
Can I use my superannuation to pay for gastric sleeve surgery?
Yes, in some cases you may be able to access your superannuation for gastric sleeve surgery. It’s best to talk to your super fund and treating doctor to find out more.
