Is Obalon Covered By Insurance?

When you’ve been trying to lose weight, it can be difficult when none of the options you have tried have worked. If diet and exercise alone are not working for you then you may be looking to other options – like surgical interventions – to help. 

Some of these options can be really expensive, though, and not everyone will have the funds to pay for them. One of the options that many doctors are recommending for their patients is call Obalon. 

What Is Obalon?

This is a nonsurgical weight loss option that takes at least six months to complete, but is normally closer to twelve for most patients. 

The procedure involved three gas-filled gastric balloons that will be placed and stay in your stomach for about six months. There will be a dietary and exercise program that all patients on this treatment must follow for the entire twelve months. 

Who Would Be A Good Candidate For This Type Of Treatment?

Ideally, people who are at least 22 years old and have a BMI of between 30 and 40 would be the best candidates. 

However, if you have had any prior stomach surgeries – like gastric bypass – then you should not use this treatment program. Additionally, for people who are extremely obese with a BMI over 40 they would likely not be considered a candidate for this treatment. 

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How Does Obalon Work?

The system works by placing the gas-filled balloons in your stomach to take up space. The space being occupied by these balloons will make you feel fuller, faster when you eat. 

In turn, you will be consuming smaller portions of food which will make weight loss easier. 

In the beginning of the treatment, your doctor will place one balloon in your stomach. In a month, they will place another balloon and then in another month they will place the third balloon. All balloons will stay in for a grand total of six months time. 

During this time, you will get a professionally designed and supervised diet and exercise routine to follow during the twelve months you are on this program. The balloons will come out after six months, but you will need to follow the regimen for the entire twelve months. 

How Much Does Obalon Cost?

The cost of this program will range, depending on where you live and which doctor performs the procedures.

From patients who have had the procedure done, they have reported paying anywhere from $6,000 and $9,000. 

Is The Obalon Weight Loss System Covered By Insurance?

Even though this procedure is approved by the FDA, it is not currently covered by any insurance companies. 

Medicare and many insurance companies would see this type of procedure as a lifestyle procedure, which means it is not medically necessary. 

If you want to get this surgery done, you will most likely have to pay out of pocket for it. The good news is that the majority of offices and clinics that do this procedure offer financing plans so that patients are not expected to pay the whole costs upfront. 

The details of each financing option will be unique to the office and what types of payment plans they offer. You will need to determine which clinic you are going to have this procedure at and talk to them about what types of costs are associated and how financing works. 

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Are There Negative Side Effects To Having The Obalon Procedure?

This procedure was approved by the FDA in 2016 and there have been minimal cases of negative side effects reported for those who have had it done. 

Since the balloons are filled with gas and therefore weight very little they are easy to tolerate and most people’s bodies are very accepting of having them in the stomach. 

For those who have had side effects after the procedure, the majority of the side effects included abdominal pain and some nausea. 

If you have this procedure done and experience severe pain or nausea, it’s advised you contact your doctor right away. They will make sure the balloons were placed properly and there isn’t anything else going on in your stomach. 

What To Expect After The Procedure?

Having this procedure is not like a magic solution to losing weight. The doctor and team of health care professionals will give a diet and exercise routine that you will need to follow for the twelve months of this program. 

There will be some hard work needed on your part to make sure you are doing the work and really want to do this. It is not going to just work on its own. 

You should only get this procedure done by a doctor who is trained in the Obalon procedure, and has experience with it. There may be other clinics who advertise lower rates but when it comes to your health you don’t want to take that risk. 

Don’t be afraid to ask questions and make sure you are completely comfortable with your doctor who will be performing the procedure. 

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Does Insurance Cover Any Form Of Gastric Surgery?

Obalon is a non-invasive procedure and doesn’t involved any surgical intervention. However, there are other forms of gastric surgery that can help with weight loss if a patient needs it. 

For example, there are gastric bands and even a complete by-pass that may be recommended for certain people. 

The types of bariatric surgeries covered by Medicare included 

  • Gastric bypass
  • Lap band
  • Duodenal switch 
  • Sleeve gastrectomy (which may be only offered at specific locations so you will have to check and see if it’s available in your area)

These surgeries can be very expensive, though too. So for people who have Medicare they may be wondering if the surgery is covered by their Medicare benefits or if they will have to pay out of pocket for all of it. 

The goods news is that Medicare does cover some gastric procedures, depending on the person and the recommendation coming from the doctor. 

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How Do You Qualify For Medicare-covered Bariatric Surgery?

Each patient will need to meet certain criteria in order to be considered for coverage by Medicare, though. 

In order to qualify for bariatric surgery, a patient must have a BMI of greater than 40 or a BMI over 35 with a obesity-related medical condition like diabetes, sleep apnea high blood pressure or cardiovascular disease. 

Additionally, you will need to have it documented that you have been obese for at least five years and have participated in a medically supervised program for weight loss and it’s not working. 

Further your doctor will need to support the weight loss surgery and recommend it as the best option for your health (and other medical conditions you may have). You will likely need to also pass a psychological evaluation to make sure you can handle the changes that this surgery will bring as it can be mentally draining as much as physically. 

When you are considering getting this surgery, your doctor will do a complete assessment on you to determine if you are a good candidate for surgery. 

What Does Weight Loss Surgery Cost? 

If Medicare is not going to cover your weight loss surgery then you may still want to go through with it, but you will need to pay for a lot of the costs out of pocket. 

For people who have gone through this, they have paid between $15,000 and $25,000 for the surgery. 

In some cases Medicare may cover part of the expenses associated with having this procedure done but you will still need to pay some out of pocket expenses. 

There are also costs associated with after care of this type of procedure. There will be a lifelong commitment to staying healthy and ensuring you get the right type of nutrition that is needed for this kind of procedure. 

Many people who have gastric procedures will need to take vitamins for life to ensure they are healthy and getting the right type of nutrition. 

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Is Weight Loss Surgery Right For You?

Having weight loss surgery is not without its risks, but it can definitely prevent major medical issues from developing in the future. 

If you are living with diabetes or another serious medical condition, losing weight to be healthier can greatly reduce the symptoms of these conditions and lessen the impact they have on your life. 

If you have questions about what to expect from having weight loss surgery, there are many groups that meet and so you can find people local to you who have gone through this and can tell you what to expect.

Doctors can give you the textbook answer as to what it is going to be like, however only people who have had the surgeries or procedures can really tell you what you may go through. It is also important to remember that each individual will experience it a little differently and some symptoms may present for others that do not present for you. 

Make an appointment with your doctor to talk about the options available to you and see if any weight loss surgery or procedure is a good fit.