Medicare Coverage for Bariatric Surgery
With the epidemic of obesity in Australia, many people are turning to weight loss surgery when dieting and exercise achieve no results. 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. These procedures are offered by surgeons in New South Wales, Victoria, Queensland, South Australia and Western Australia. Many patients ask will Medicare pay for my post-bariatric surgery?
But does Medicare cover or pay for bariatric surgery?
Qualifying for Bariatric Surgery
If you are looking to undertake lap band, gastric sleeve or gastric bypass surgery, Medicare requires that your BMI (body mass index) be at 30+. Further, for gastric balloon, you need to be at 27+ BMI. If you have a BMI between 30 to 39.9, Medicare requires you to demonstrate other, certain health problems to qualify for coverage. A BMI of 40 or higher however will qualify you for aid with or without other related health issues.
HEALTH PROBLEMS AT A BMI OF 30 OR HIGHER:
- Poorly controlled type 2 diabetes
- High risk of cardiovascular disease
HEALTH PROBLEMS AT A BMI OF 35-39.9
Must also have one or more obesity-related health problems including:
- Liver disease
- Sleep apnea
- Sleep deprivation
- Stress Incontinence
- Cardiovascular disease
- Metabolic syndrome
- Non-alcoholic fatty liver disease
- Pseudo-tumor cerebri
- Venous stasis disease
- Carpal tunnel
- Dyslipidaemia Hypercholesterolemia
- Effectiveness of oral contraception
- Gall bladder disease
HEALTH PROBLEMS 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.
PATIENTS WHO QUALIFY FOR BARIATRIC SURGERY ARE:
- At least 36 kg overweight
- Between 18-75 years old
- Able to demonstrate a history of failed weight loss attempts
- Thoroughly understand that weight loss procedures are a tool and that long term success also require significant diet and lifestyle changes
- At a BMI of 30 or more
Four Most Common Weight Loss Procedures
The four most common types of bariatric surgery in Australia are:
- 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
The final price of your procedure will also depend on a number of factors. These include:
- Whether you are insured or uninsured
- Initial surgeon and GP consultation fees
- Type of procedure being performed
- Surgeon fees
- Surgical assistant fees (if req)
- Hospital fees
- Anaesthetist fees
- Medications 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. Weight loss surgery is also 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.
If your MBS item code is changed due to the November 2018 update, you may get less or no rebate. To find out if you are covered, discuss this with your specialist.
In Bali we offer Gastric Sleeve at 150, 000,000 IRO for 4-5 night in hospital and a 10-14 day package with the Courtyard Marriot Nusa Nusa together with Bali International Medical Centre.
|Procedure||Price/AUD||Hospital Admission/Nights||Total recommended Stay/Day|
|Gastric Sleeve surgery||$14,000 AUD||3-4||>14|
– Pre-surgery check-up such as CBC, BUN, Cr, Electrolyte, EKG, Chest X-Ray and EDG procedure (To be done 1 day before the surgery with following pre-admission. Client must undergo NPO 8 hrs. before appointment time; and NPO again 8 hrs. before surgery)
– Admission to the hospital in a private room: 3-4 nights (1 night before surgery, 2-3 nights after surgery);
– Operating theater fee
– Anesthetic fee
– Surgical fee
– Follow up visit after operation
– Extra tests (if client has any underlying disease) are not included in the package cost and need to be paid separately (e.g. EST, TFT, Blood Sugar etc.) The same for specialist’s consultations.
– Pre-surgery consultation with Dr. Thakoon is included, other specialists (if needed) should be paid extra.
Phuket stay: Must not be less than 14 days so 10 nights hotel stay.
Once our medical team has approved you for gastric sleeve surgery, you may be required for more extra check at the hospital before the surgery for an echocardiogram to ensure about your AF condition, and when come for surgery please bring all your previous test reports and your current medication as well.
The surgery will be done as keyhole surgery which is less invasive and gives a quick recovery. The surgery reduces your stomach 80%, leading to weight loss. After the surgery you will feel full faster, patients will usually lose 50-70% of the excess weight. We will provide further information in a guidebook and medical information prior to your journey and on confirmation.
Our Bariatric Surgeons in Bali, Thailand as well as Mexico are Board Certified General Surgeon’s with extensive experience in keyhole and bariatric surgery.
Gastric Sleeve Packages = Include:
– Gastric sleeve surgery
– Routine pre-op check up, abdominal ultrasound, Gastroscopy, blood test
– 5 nights admission in the hospital
– 10 nights in 4 star hotel (deluxe room) with daily breakfast (single occupancy)
– Transfers between hotel, hospital, and airport
*The price is fixed in currency. AUD is subject to currency fluctuations.
*The price excludes the flights and extra treatment for underlying disease.
How to book ?
The first step is to inquire here and confirm your suitability with our doctor and medical team.
☎️1300 NIP TUK -1300 (647 885) 🕹E: [email protected]
- How to pay for the Surgery?
In case you need finance or payment plans here are the options: https://medical.tlc.com.au/apply-now/?prnid=NTM1
3. Superannuation Early Release
Gastric Sleeve is eligible for early release of superannuation. Let me know if you wish to explore this option, and I can assist guide you through the process.Click here to download the early release of superannuation report: https://bit.ly/2FojTwN
2. PAYMENT PLAN / Loan
We work with TLC to help provide flexible funding options for our clients. From $70 per week. Apply now and they will get back to you within 2 days:https://medical.tlc.com.au/apply-now/?prnid=NTM1
The sleep apnea test is required to ensure your safety. Please have the sleep test done and send me the report. If you don’t have the sleep apnea problem, you can get the letter from GP stating that you have low risk and fit for gastric sleeve surgery without sleep test.
Guidelines for your itinerary:
Day 1 : Arrival
Day 2 and Day 3: Pre-surgery screening, check up and consultation with doctors at hospital Abdominal Ultrasound, Gastroscopy under GA, Routine Lab test, consultation with GI, Endocrine and chest doctor.
Day 4 : Check out from hotel and Admit to hospital for Gastric Sleeve surgery
Day 9 : Discharge from hospital and return to hotel for recovery (Follow up appointment is to be advised)
Day 16: Fly back home
Four (4) weeks before surgery:
1.Discontinue taking Anticoagulant Medication such as Aspirin, Heparin, Warfarin or other drugs that affect blood clotting and blood thinning. Maintenance medicines for existing medical or metabolic disorders (e.g. hypertension, diabetes, thyroid problems, etc.) should not be discontinued. We recommend you to see your doctor for proper advice before surgery.
2.Discontinue taking Vitamins, especially Vitamin E and Fish Oil, and food supplements, birth control pills and other hormones.
3.Abstain from smoking and alcoholic drinks to ensure optimal wound healing and minimize post-surgical complications.
4. You will have to start to control your diet 2 weeks prior to your surgery. It is recommended to prepare your body with a small portion of food in each meal with no sugar, low carb and low fat. Recommended food is lean meat, eggs, vegetables or unsweetened fruits.
Please note that side effects after gastric sleeve may be digestion issues and you may have loose skin due to rapid weight loss. You should discuss about the possible issues with the surgeon before surgery. We recommend you bring along a support person or partner to join the trip too.