How Much Does Weight Loss Surgery Cost?

What is weight loss surgery? 

In general, weight loss surgery (also known as bariatric surgery) is to reduce your stomach size so you feel fuller sooner. 

The three main types of weight loss surgery you might see recommended are: 

• Gastric sleeve surgery (sleeve gastrectomy): a large portion of your stomach is removed, helping you feel less hungry and reducing how much of the hunger hormone (ghrelin) you produce.
• Gastric bypass surgery: the top of your stomach is rerouted to the lower part of your small intestine, meaning you absorb fewer calories.
• Lap band (gastric band) surgery: a small adjustable ring is placed around the top of your stomach to reduce its volume and slow the entry of food, helping you to feel full after a smaller amount of food. 

In Australia, Gastric sleeve surgery is the most common. 

Weight loss surgery provides numerous benefits by improving obesity management. This can lead to better diabetes control, lower blood pressure, enhanced quality of life, and improved heart health. Usually, you’ll have to have tried other ways to lose weight, like changing your diet and exercise, while also meeting certain clinical requirements. For instance, you may need to have a BMI above 40, or a BMI above 35 along with a serious health problem, like diabetes or heart disease. 

The kind of weight loss surgery you get can depend on your BMI, as well as your general health. Plus, as different technology and approaches become more commonplace, you could be recommended other forms of bariatric surgery, like a gastric balloon. 

Regardless of which option your doctor recommends, you might only need to lose 5% of your total weight to start seeing some improvement in any weight-related complications or conditions.¹Obesity Evidence Hub – Medication and surgery for adults To put that in perspective, a year after having surgery, patients can find they’ve lost 15% of their body weight, if not as much as 30%.²As above This depends on the type of surgery you have, though. And of course, it’s very normal to regain some weight as the years pass, as your body adjusts and you establish a new lifestyle.

What’s involved in weight loss surgery?

Helpful Tip:

If you decide with your doctor that weight loss surgery would benefit your health, you’ll need to be patient whether you go through the public or private systems. If you already have a gold policy and you’ve held it for at least 12 months, weight loss surgery will be covered and you should be able to get the ball rolling pretty quickly.  But remember, if you don’t have an existing insurance policy that covers bariatric surgery as a hospital category, you’ll be looking at a 12 month waiting period from the day that you take out the policy.

Dr. Jill Gamberg

GP, Coach and Lifestyle Medicine Coach

What happens after my weight loss surgery? 

Once home, you’ll need to be prepared to see your GP regularly for check-ups and blood tests to hopefully catch any issues early (if you have any). Plus, you might need to work with a dietitian to help change your eating habits, as well as make sure you’re getting the nutrients you need. This could include ongoing vitamins and supplements. Similarly, an exercise physiologist or physiotherapist can help you build up your exercise levels and establish a more active lifestyle.  

Long-term management can be tricky, as your body naturally counters weight loss with certain defences, like changes to your hormones and increases in your appetite. It’s generally recommended that you work with appropriate healthcare professionals to establish a realistic and tailored lifestyle, to support and maintain your weight loss.

What could I have to pay for weight loss surgery? 

All of the surgeries described above are covered by Medicare if you choose to use the public hospital system. That means they’re free, as long as you have Medicare entitlements. 

They can also be covered by health insurance, although your out-of-pocket cost — and whether you have one at all — can vary. The graphs below will give you an idea of what out-of-pocket costs you could expect, as well as an understanding of what fees your insurer could cover.

What out-of-pocket costs could there be? 

It can be hard to nail down an exact figure for your out-of-pocket costs. This is because it can vary depending on your individual situation, including the surgery you have, the specialist you choose, your health insurance policy and your insurer. 

To start with, there could be a discrepancy between what your specialist charges and what your insurer will pay. This is known as the ‘gap’, which you’ll need to take care of.  

Additionally, your policy will likely come with an excess. This is an amount you’ll need to pay before your insurer will accept your claim and start covering part or the rest of your fee. Similarly, your policy could include a co-payment — a fee for each day you’re in hospital.  

Having out-of-pocket costs isn’t necessarily a bad thing. For example, strategically opting for a higher excess or choosing a co-payment option could be a way you make your health insurance premiums more affordable.

What other costs could there be for weight loss surgery? 

As discussed above, weight loss surgery is only part of the puzzle for losing weight and maintaining that success. You might need to work with a broader healthcare team, including a dietitian and physiotherapist, to create an achievable lifestyle plan that meets your weight loss needs.  

As part of this, if you have a related chronic condition, like diabetes or heart disease, speak to your GP about  a chronic disease management (CDM) plan.   If you fit the eligibility criteria for a CDM, you may access Medicare rebates from allied health professionals like dietitians and physiotherapists.  

Of course, your rebate may not fully cover your specialist’s fees. For instance, dietitian fees tend to range between $50 to $150, but your rebate might not extend that far.  Each CDM plan has only a certain number of eligible visits on it.  

If you aren’t eligible for a CDM plan — or you’ve used up all your sessions — your health insurance might have you covered. Depending on your insurer and policy, you might be able to claim some of the costs for a weight management program. This might even include a gym membership to put some of your healthcare team’s recommendations into practice. 

You will also have ongoing costs for over-the-counter vitamins and supplements. This is because weight loss surgery can sometimes reduce your ability to absorb the nutrients you need. Unfortunately, Medicare and your health insurance won’t cover these, as they’re neither part of the Pharmaceutical Benefits Scheme nor the kinds of prescribed medications that insurers would usually recognise.

How long will I have to wait for weight loss surgery? 

In the case of bariatric surgery, patience isn’t just a virtue — it’s more like a requirement. Within the public system, wait times can be extremely long, potentially up to a few years. 

In the private system, you could have a shorter wait. However, when it comes to waiting periods — how long you’ll have to wait after getting health insurance before you can start claiming — you’ll likely need to sit tight for 12 months. This is because obesity is usually treated as a pre-existing condition. 

You might want to keep in mind, though, that while both systems are likely to come with a long wait, choosing to use your health insurance and going private means you’ll at least get the benefits of being a private patient, like picking your specialist and potentially even getting a private room for those few days of recovery after.

What level of health insurance covers weight loss surgery? 

As standard, gold tier health insurance policies need to include cover for bariatric surgery. Insurers are also allowed to offer it at lower levels but there could be some restrictions.

Does health insurance cover any alternatives to weight loss surgery? 

Outside of surgery, you could be recommended other medical interventions to help you lose weight. This can include the following medications: 

• Phentermine (known as Duromine or Metermine)
• Orlistat (known as Xenical)
• Liraglutide (known as Saxenda)
• Naltrexone-Bupropion (known as Contrave) 

These are the only prescription weight loss medications approved by the Therapeutic Goods Administration (TGA). However, the Pharmaceutical Benefits Scheme doesn’t cover them.  That means, based on the highest dosages and 2021 prices, you could be spending an average of $216.50 each month to take them. That is, unless you have health insurance. Of course, it depends on your insurer and policy, but they may cover some of the cost. 

Please note, though, that your insurer is unlikely to cover Ozempic. While Ozempic is marketed overseas as a weight loss drug, it’s not registered with the TGA as one. In Australia, it’s recognised as a type 2 diabetes medication instead. If you’re prescribed Ozempic for weight loss, this will be ‘off-label.’ So even though Ozempic is technically a TGA medication, its use as a weight loss drug isn’t TGA approved, likely meaning your insurer won’t accept a claim for it if you’ve been prescribed it for anything other than type 2 diabetes.  

Beyond medications, you could be recommended weight management programs or services, like visiting a dietitian or even getting a gym membership. While it can depend on your policy and insurer, you may be able to get cover from your health insurance for these kinds of expenses.

Where can I find and compare health insurance? 

Our weight can be a loaded and difficult subject. However, your healthcare team may recommend weight loss surgery to help manage other conditions or overall improve your health and quality of life. If this is the case, health insurance could help you to prioritise your health and wellbeing by giving you the option to use the private hospital system, as well as make the most of aftercare strategies and services. 

Finding a policy, though, can be tricky. But that’s why there’s iSelect. With us, you can compare a range of health insurance options from different providers online. Alternatively, you can call one of our health comparison experts on 1800 784 772. Either way, you can wrap your head around a number of policies and pick the one that offers you the most value in a matter of minutes.