Is ESG Weight Loss Covered By Insurance?

A staggering three-quarters of adults in the United States now struggle with being overweight or obese. This figure has tripled since the 1960s and shows no signs of decline. Consequently, the need for effective and accessible obesity treatment has never been higher.

Since the introduction of bariatric surgery in the late 1960s, there have been incredible advancements in the field of bariatrics. Today, procedures like gastric balloon and endoscopic sleeve gastroplasty (ESG) offer low-risk, non-invasive options for treating obesity without the need for surgery.

Despite these advancements and the tremendous need, barriers such as financial constraints and navigating insurance coverage continue to hinder access to vital treatment for many patients battling obesity. Here’s what to know about ESG insurance coverage and other options that may be available to you.

Is Endoscopic Sleeve Gastroplasty (ESG) Covered by Insurance?

Sadly, Endoscopic Sleeve Gastroplasty (ESG) is not typically covered by insurance. There have been select cases in Massachusetts and West Virginia where coverage has been obtained, but the process for determining eligibility is rather arduous and complicated.

Even then, most patients have to pay for the procedure upfront and get their insurance to pay them back later, which isn’t guaranteed. This is a tremendous disservice to patients who don’t meet the qualifications for bariatric surgery or prefer a non-invasive treatment option for various reasons.

Why Isn’t ESG Covered By Insurance?

The main reason ESG isn’t covered by insurance is because it’s a relatively new procedure, despite ESG having full FDA authorization as an effective weight loss intervention. Most providers simply don’t have a proven track record of success and aren’t formally trained in endoscopic weight loss techniques

Currently, there are only two formal advanced fellowship programs for ESG and advanced endoscopic weight loss in the United States. One is offered by Dr. Pichamol Jirapinyo and Dr. Christopher Thompson, our founders and the Director of Endoscopy and Co-Director of the Center for Weight Management at Brigham and Women’s Hospital.

This program is leading the way in training specialists, but the limited availability of such training means that the procedure is not yet mainstream. As ESG continues to gain recognition and more data becomes available. It is likely that the procedure will be covered by insurance in the future.

Will ESG Be Covered By Insurance in the Future?

Lower BMI requirements and effective, low-risk procedures like ESG can alleviate many of the barriers that have kept patients from obtaining treatment for obesity. Unfortunately, financial constraints and lack of insurance coverage are still standing in the way of many receiving the help they need.

However, there is hope on the horizon, as there is a good chance that ESG will be covered by insurance in the future. Here’s why:

ESG Is a Safe and Effective Procedure for Weight Loss

Clinical trials have shown that ESG is a safe and effective procedure for weight loss, with most patients losing an average of 18% of their body weight. Patients also experienced a reduction in obesity-related comorbidities and an improved quality of life.

This impressive data prompted the FDA to approve ESG for weight loss in June 2022. FDA approval is a significant step towards gaining insurance coverage, as it validates the procedure’s efficacy and safety.

ESG Has Fewer Risks and Complications

The truth is medical insurance companies are in the business to make money. Naturally, they want to mitigate their risk of financial obligations, and surgical complications cost them money. ESG has been shown to have fewer complications than gastric sleeve surgery, the most commonly performed weight loss surgery covered by most insurance plans.

ESG Is Less Expensive Than Bariatric Surgery

ESG is an outpatient procedure that does not require a hospital stay. In contrast, gastric sleeve surgery typically requires a three-day hospital stay. Hospital stays typically cost around $3000 dollars a day, equating to a cost of $9000 or more for the hospital stay alone.

Additionally, the cost of gastric surgery itself is much more expensive than an outpatient, endoscopic weight loss procedure like ESG. The average cost of ESG is around $12,000 total, while the average cost of bariatric surgery can range from $17,000 to $26,000 or more.

Losing Weight Reduces Health Risks

Treating obesity can dramatically improve the patient’s overall health. It can also significantly improve or resolve the symptoms of chronic health conditions like sleep apnea, type 2 diabetes, hypertension, asthma, and much more. By reducing these health risks, the overall healthcare costs associated with obesity can be decreased. 

Insurance companies in the US spend billions of dollars each year treating obesity-related conditions. By covering effective weight loss treatments like ESG, insurers can potentially reduce these long-term costs.

Obesity Costs Employers Time and Money

Employers in the US are also affected by lost employee productivity related to obesity and chronic illness. Healthier employees mean fewer sick days and higher productivity, which can indirectly save employers money due to lower premiums and fewer claims.

So, what does all of this mean? Offering insurance coverage for endoscopic sleeve gastroplasty (ESG) has the potential to save insurance companies a lot of money. Not only is this outpatient procedure more cost-effective than surgery, it also has the potential to lower the costs of prescription drugs and other treatments associated with obesity-related illness.

What Can I Do If My Insurance Company Does Not Cover ESG Weight Loss?

While the likelihood that Endoscopic Sleeve Gastroplasty (ESG) will be covered by insurance in the future is great news, many patients need help losing weight now. Thankfully, there are some great options available for patients who don’t want to wait until ESG is approved by their insurance provider!

Patient Financing Options

Bariendo works with two premier financing partners that offer patient financing options for procedures that aren’t currently covered under their medical insurance plan, including ESG stomach tightening and non-invasive gastric balloon. This option helps make these procedures more accessible by allowing patients to spread the cost out with manageable monthly payments.

Flexible Spending Accounts (FSAs)

You may also be able to take advantage of a Flexible Spending Account (FSA) that is specifically for health-related expenses. FSAs allow you to set aside pre-tax dollars from your paycheck to cover eligible medical expenses.

Health Savings Accounts (HSAs)

Similar to FSAs, Health Savings Accounts (HSAs) are another potential option for covering medical expenses with pre-tax dollars. HSAs are available to individuals with high-deductible health plans and can be used to cover eligible expenses that are not covered by insurance.

Medical Credit Cards

Some companies offer medical credit cards specifically designed to cover healthcare expenses. These cards typically come with special financing options, which can help manage the costs associated with procedures like ESG.

How Do You Qualify for Endoscopic Sleeve Gastroplasty?

Generally, ESG is a good option for patients with a Body Mass Index (BMI) of 30 or higher who have not been successful with traditional weight loss methods. It may also be available to patients with a lower BMI who have obesity-related health conditions.

To find out if you’re a good candidate for ESG, schedule a free consultation with the team at Bariendo. Our caring experts are here to help you create a customized plan for weight loss success based on your personal needs and goals.

Don’t let insurance coverage barriers stand in the way of achieving your weight loss goals. Explore the various financing options available to make ESG more accessible! With the potential for insurance coverage in the near future and the numerous benefits of ESG, now is a great time to take the first step towards a healthier, happier you!