Medicare Cover for Bariatric Surgery – How to fund your Bariatric Surgery
With the epidemic of obesity in Australia, many people are turning to weight loss surgery when dieting and exercise achieve no results. Many overweight patients ask will Medicare pay for my post-bariatric surgery? Weight loss surgery in Australia requires that your BMI needs to be at least 30 and includes specific procedures such as gastric sleeve, gastric bypass, lap band, and gastric balloon.
Weight loss surgery or bariatric procedures are offered by surgeons in New South Wales, Victoria, Queensland, South Australia and Western Australia.
You can find out who are the best weight loss surgeons and best post-weight loss bodylift plastic surgeons in Australia by visiting the www.newbodyspecialists.com.au website.
Download Our Weightloss Surgery Guide
Does Medicare cover or pay for bariatric surgery? – Do you qualify?
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, however, will qualify you for aid with or without other related health issues.
Health Problem Criteria at a BMI of 30 or Higher:
- Poorly controlled type 2 diabetes
- High risk of cardiovascular disease
Health Problem Criteria at a BMI of 35-39.9
Must also have one or more obesity-related health problems including:
- Carpal tunnel
- Dyslipidaemia Hypercholesterolemia
- Effectiveness of oral contraception
- Gall bladder disease
- Liver disease
- Sleep apnea
- Sleep deprivation
- Stress Incontinence
- Cardiovascular disease
- Metabolic syndrome
- Non-alcoholic fatty liver disease
- Pseudo-tumor cerebri
- Venous stasis disease
Health Problem Criteria at a BMI of 40 or Higher
- No health problems required to qualify
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.
Ideal Patients who Qualify for Bariatric Surgery 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
4 Most Common Weight Loss Procedures
Below lists the four most common types of bariatric or weight loss surgery in Australia:
- Gastric sleeve also called vertical sleeve gastrectomy or sleeve gastrectomy
- Gastric Bypass or Roux-en-Y gastric bypass
- Lap band or adjustable gastric band (Less popular now)
- Gastric Balloon – a newer “in-between” option that is more aggressive than diet and exercise but less aggressive than other bariatric procedures.
Cost of Weight Loss Surgery in Australia
Unfortunately, there is no one price for the procedure. This is because 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
- Anaesthetist fees
- As well as, medications you need post-surgery
For 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, after the November 1, 2018 update, some of the Medicare Benefit Scheme changes may impact your ability to receive a rebate for surgery. Further, weight loss surgery is not fully covered under Medicare and will incur some out-of-pocket expenses. However, most weight loss surgery is performed under Private Health Insurance and is accessible to most Australians.
The most common Medicare Item Numbers used for Weight Loss Surgery in Australia are
- Item Number 31575 for Sleeve Gastrectomy
- Item Number 31572 for Gastric Bypass Surgery
- Item Number 31369 for Lap Band Surgery (Item 31584 for Lap-Band Removal)
You can find out more information and criteria for Medicare Item Numbers at the MBS Website
Download our Guide to Medicare and Health Insurance for Plastic Surgery
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. Further, 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. Many surgeons will also 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.
Visit www.newbodyspecialists.com.au for a directory of Australian Bariatric Surgeons and an overview of different types of bariatric surgery.