Detailed cost guide
A Comprehensive Guide to Bariatric Surgery Cost in Los Angeles, CA
The obesity epidemic is a very serious public health concern, and bariatric surgery can be a very effective treatment option for losing weight and improving other health issues related to obesity. For the people of Los Angeles, CA, understanding the cost of many bariatric surgical options is an integral step in making good healthcare decisions. This guide will cover the costs associated with some of the most common bariatric surgery procedures, what types of insurance and financing may be available, compare the costs of undergoing bariatric surgery with using GLP-1 medications and answer frequently asked questions about bariatrics specifically for the city of Los Angeles.
Los Angeles Bariatric Surgery Overview
Generally speaking, you can expect to pay between $15000 – $25000 for bariatric surgery in Los Angeles depending upon the specific procedure, who will perform it, and where you have the procedure done. The costs typically cover the following:
– Pre-operative testing and consultation (laboratory tests, doctor visits)
– Surgical fee and anesthesia fees
– Hospital stayed (if performed in hospital)
– Post-operative care/aftercare (usually for approximately 90 days)
Many times, the office or surgical center will include nutrition or dietary counseling and/or participation in support groups in their costs. Some costs may differ based on:
– Surgeon’s familiarity with the procedure and experience
– Facility where surgery is performed (hospital versus surgical center)
– Payer/PPO vs.non-Payer/PPO
– Any unique characteristics of the patient that would influence billing or rate of reimbursement
– Any additional out-of-pocket costs related to ancillary items (vitamins, supplements, additional counseling after discharge, managing a complication after surgery).
Types of Bariatric Surgeries and Their Estimated Costs
1) Gastric Sleeve
The gastric sleeve procedure involves removing approximately 80% of the stomach to create a tubular pouch, which reduces the size of the stomach and reduces the production of the ghrelin hormone, which regulates appetite. This is one of the most commonly performed surgeries due to its effectiveness and low complication rates.
Estimated cost from:
– Los Angeles: $17,000 – $19,000;
– National Average: $10,000 – $26,000 (outpatient centers).
2) Roux-en-Y Gastric Bypass
The Roux-en-Y gastric bypass is a procedure that creates a small pouch from part of the stomach and then reroutes a portion of the small intestine to it; thus significantly reducing both the number of calories you can take in (restrictive effects) and the number of calories you absorb (malabsorptive effects). This is one of the most effective procedures for weight loss and for resolving co-morbidities associated with the obesity epidemic.
Estimated cost from:
– Los Angeles: $18,000 to $21,000;
– National Average: $15,000 to $35,000.
3) Mini Gastric Bypass
The mini-gastric bypass is a less invasive option for gastric bypass surgery, providing a longer and narrower pouch and rerouting the intestine with a simpler procedure. This results in restrictions of food intake as well as restrictions of calorie absorption.
Estimated costs from:
– Los Angeles: approximately $18,000 – $20,000 (costs can vary by facility)
Note: Pricing tends to be less standard and often contained within RNY bypass bundled packages.
4) Gastric Plication
Gastric plication is an operation where the stomach is folded back on itself and sewn to decrease the volume of the stomach. No stomach tissue is removed or manipulated. The gastric plication operation is relatively less invasive because the stomach’s anatomy is preserved.
Estimated costs from:
– Los Angeles: $16,000 to $18,000
Note: Please check with your insurance company, as there is less insurance coverage compared to other operations and each insurance company may have its own individual policies.
5) Gastric Balloon
The Gastric Balloon is a renascence procedure that involves placing a saline-filled balloon into the stomach with an endoscope. The balloon reduced the size of your stomach and is temporary; you can have it removed or replaced at any time. If you are looking for a non-invasive weight loss procedure and do not qualify for surgery, your doctor may suggest using gastroplasty as an alternative to other surgical options.
Estimated cost from:
– Los Angeles: $4,000 to $5,000
– National Average: $4,000 to $9,000
6) Gastroplasty
Gastroplasty is one of the earlier ways to restrict appetite and can be distinguished between an older vertical banded gastroplasty and a newer endoscopic sleeve gastroplasty. The procedure to create a much smaller stomach with either stapling or suturing vs. a sleeve gastrectomy or gastric bypass. Generally speaking, the gastroplasty is typically not done. Your doctor would recommend a procedure like the sleeve gastrectomy or gastric bypass.
Estimated cost from:
– Los Angeles: $15,000 – $17,000 but little data is available for ESG on its own.
Bariatric Surgery Pricing at Leading Los Angeles Centers
Coverage by Different Insurance Providers for Bariatric Surgery in Los Angeles
Common coverage criteria for insurance companies that cover bariatric surgery for patients:
• Body Mass Index (BMI) ≥ 40 or 35+ (with obesity-related conditions such as diabetes, sleep apnea, and hypertension).
• Documenting previous attempts (medically supervised) of weight loss programs and failure.
• Psychological evaluation (assessing mental readiness).
• Pre-operative Medical & Nutritional Counseling.
Recently, some insurance companies have started to lower BMI criteria for various populations (e.g. Asians with a BMI of 25-27.5) as per the American Society for Metabolic & Bariatric Surgery (ASMBS).
Event/Plan for Checking Your Coverage
1) First you will need to check with your insurance, they will be able to provide specific info on your coverage (some of the insurance companies that usually provide coverage for bariatric surgery via Pre-Authorization are Aetna, Anthem, Blue Shield of California, CIGNA, United Healthcare).
2) Most major PPOs (Preferred Provider Organizations) will cover bariatric surgery unless prior authorization was not obtained, this will be the best way for you to ensure coverage before your surgery.
3) For Medi-Cal [California’s Medicaid], you will need to follow specific requirements for Medi-Cal coverage and you will need to submit a Treatment Authorization Request to your Medi-Cal Managed Care Plan for your surgery [also referred to as “TAR” by Medi-Cal and/or “TAR’s” for Medicare]. Medi-Cal Managed care plans will assist you with this.
4) Kaiser Permanente Southern California will provide coverage for your surgery but typically do not have any self-pay options.
5) Many surgery centers have experience submitting “Letters of Medical Necessity” and assisting with appeals of denials.
For Patients with No Insurance or Limited Insurance:
1) Payment Plans, most of which have no or low down payments and offer monthly payment options.
2) Providers of Medical Lending: Examples are Prosper Healthcare Lending, Cherry Payment Plans, and PatientFi.
3) Providers of Medical Credit Cards: Example is CareCredit (offering lower interest than a standard credit card).
4) Some practices in Los Angeles will provide their own financing to their patients.
Comparing Bariatric Surgery Costs to GLP-1 Medication Expenses
The arrival of GLP-1 receptor agonists offers a non-surgical alternative for weight loss.
GLP-1 Medications Commonly Used
| Medication | Monthly Cost (USD) | Annual Cost (USD) | Notes | Source |
|---|---|---|---|---|
| Wegovy (semaglutide) | $349 – $499 | $4,188 – $5,988 | Manufacturer offers cost reduction programs; insurance coverage varies. | Novo Nordisk |
| Zepbound (tirzepatide) | $399 – $549 | $4,788 – $6,588 | LillyDirect offers self-pay pharmacy prices starting at $349/month for low doses. | Lilly |
| Ozempic (Semaglutide) | Up to $1,500 | Up to $18,000 | Primarily diabetes medication, but off-label for weight loss; prices vary widely. | Axios |
| Mounjaro (Tirzepatide) | ~$1,000–$1,200 | $12,000 – $14,400 | FDA approved for type 2 diabetes; weight loss use growing; high out-of-pocket cost for uninsured. | Manufacturer websites, GoodRx |
Important Points to Keep in Mind
– A bariatric surgical procedure involves an initial upfront expenditure that could result in many years of future benefit (both healthwise and financially).
– GLP-1’s will require multiple years of use, accumulating annual costs that could potentially exceed the cost of surgery (over the years).
– For chronic weight management, very few health plans provide coverage for GLP-1’s (the difference between health plans is substantial).
– The Kaiser Permanente study indicates that the average healthcare cost for surgical patients was lower than non-surgical patients five and one half years following surgery (excluding the cost of surgery).
Los Angeles, CA Frequently Asked Questions (FAQ)
What is the BMI criterion for qualifying for bariatric surgery?
In order to qualify for bariatric surgery, an individual must have a BMI of either 40 or over (Morbid) or 35 or more with a comorbidity (type 2 diabetes, sleep apnea). Insurers also often require proof of having attempted to lose weight unsuccessfully before they will approve the procedure, as well as psychological clearance prior to surgery.
Is there a way to verify whether my insurance will cover bariatric surgery?
You can confirm insurance coverage for bariatric surgery by contacting your insurance provider directly. In addition, most surgical centres will have financial counsellors who can help with insurance verification, pre-authorizations, and appeals.
Are there options to pay for the bariatric surgery if I do not have any insurance?
Yes. In-house payment plans, medical financing companies (ie: Prosper, Cherry), Care Credit, and other outside sources are all possible methods of obtaining financing for bariatric surgery. It is important to speak with your surgeon’s office about financing options as soon as possible.
What type of post-operative care and recovery will be required after bariatric surgery?
The typical length of a surgical admission is 1-3 days, but complete recovery from the surgical procedure may take several weeks to months depending on the type of surgery and following your surgeon’s post-operative instructions. Post-operative care will include nutrition counseling, follow-up appointments with your physician, and, often, attendance at lifestyle modification support groups.