I need to negotiate with an academic medical center for a fair fee for
gastric bypass surgery.  How much do most isurance companies pay for
this procedure (laproscopic RNY?

Hello nancydrew1965,

 According to this USA Today article, the average cost for gastric
bypass surgery is $24,000.

http://www.usatoday.com/news/health/2002-01-21-obesity.htm
USA Today
"Weighing the cost of obesity"

By Nanci Hellmich, USA TODAY 


According to this CNN article, the surgery can be $30,000. Most of
these types of surgeries probably fall within this range.


CNN
"Gastric bypass coverage dropped by insurer"
March 3, 2004

Search terms:
gastric bypass insurance
blue cross blue shield gastric bypass

If you need any additional help or clarifications before rating, let
me know and I'll be glad to help.

--keystroke-ga

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Request for Answer Clarification by nancydrew1965-ga on 02 Oct 2006 16:05 PDT

Hi,
I know what the fees are, but what does the insurance company ACTUALLY
PAY?  I'm sure it is much less that the that is fee charged.

ND

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Clarification of Answer by keystroke-ga on 02 Nov 2006 09:23 PST

Hello nancydrew1965,

I could find no cases of insurance companies paying less than the
surgery is worth-- I do know that many insurance companies have a
practice to do this, but that is more for physical therapy-type
treatments and not large surgeries like gastric bypass. If physicians
are not making money on these surgeries, they will not conduct them.

The insurance companies know how much these surgeries are worth and if
they think that it will save them money on health costs in the long
run, they'll pay for them.  If it does not save them money on health
costs in the long run, they will not pay for them.  Medicaid and
Medicare pay less than the scheduled price for surgeries, but it will
most likely not help you to try to negotiate the Medicaid cost; many
doctors won't treat Medicaid or Medicare patients because they receive
so much less to treat them.

Here are some examples:

About.com Medicaid coverage
http://experts.about.com/q/Medicare-Medicaid-Insurance-992/gastric-bypass-2.htm

$20,000 to $35,000
"A gastric bypass cost varies from around $20,000 to $35,000."
http://ezinearticles.com/?What-Does-A-Gastric-Bypass-Cost?&id=329251

$20,000 to $35,000
http://www.obesitytopics.com/2006/08/18/what-does-a-gastric-bypass-cost/

"For the obese patient who has tried everything and failed to loss
weight, the gastric bypass cost is a small price to pay for a lifetime
free from obesity and its related healthcare problems."

If you could get the cost down to $20,000, you'd be doing great.

Search terms:
gastric bypass actually paid insurance
gastric bypass cost insurance

Let me know if you need any additional help.

--keystroke-ga