Gastric Bypass Surgery Including Excess Skin Removal: FSA Eligibility

Gastric bypass surgery including excess skin removal is eligible for reimbursement with a flexible spending account (FSA), health savings account (HSA), or a health reimbursement arrangement (HRA). Gastric bypass surgery including excess skin removal is not eligible with a dependent care flexible spending account (DCFSA), or a limited care flexible spending account (LCFSA).

What is gastric bypass surgery?

Gastric bypass surgery, also known as weight loss surgery, includes a variety of procedures performed on adults who have severe obesity. It is an option for weight loss for those where obesity poses severe health complications. Clinically severe obesity is defined as those who have a Body Mass Index (BMI) greater than 35. Some of the health problems that adults with obesity could experience include Type 2 diabetes, heart disease, severe sleep apnea, and others.

What are the benefits and/or consequences of gastric bypass surgery?

Results of gastric bypass surgery vary and there is no sure method to produce and maintain weight loss. Studies have shown that the procedures can cause significant long-term loss of weight, improvement in cardiovascular risk factors, and a reduction in mortality. However, some patients who have gastric bypass surgery may only have a marginal weight loss or even regain some of the lost weight over time. In the long term, success may be more contingent on curtailing habits and constant medical follow-ups.

When should one consider getting gastric bypass surgery?

Recent NIH guidelines suggest that any patient with a BMI of more than 30 is a candidate for gastric bypass surgery, and it is recommended if BMI is at least 40 or if patient has serious health conditions. Not all patients are suitable for gastric bypass surgery so it is best to consult a doctor on whether gastric bypass surgery is the right option.

Gastric bypass surgery is also sometimes used to treat youth with extreme obesity. Experts in childhood obesity suggest that families consider surgery only after they have tried for at least 6 months to lose weight and have been met with little to no success.

How much do gastric bypass procedures cost?

On average, costs range from $20,000 to $25,000. Gastric bypass surgery may be covered only under certain conditions:

  • If the patient has at least one health problem linked to obesity
  • If the procedure is suitable for the patient's medical condition
  • If approved surgeons and facilities are involved

Eligibility Table

Flexible Spending Account (FSA) Limited Care FSA Dependent Care FSA Health Savings Account (HSA) Health Reimbursement Account (HRA)

Eligible

Eligible with Rx

Eligible with LMN

Not Eligible

Specifically Not Covered

Excess skin removal is related to a cosmetic purpose, so if necessary for medical treatment, it would only be eligible with a Letter of Medical Necessity (LMN).

 


AZ-PROD-WEB02 11/21/2017 5:42:10 PM