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Participating Health Funds

Gastric Banding

fat man border

Laparoscopic gastric banding surgery involves a band being fastened around the upper stomach to restrict the amount of food that can be consumed.

Since its introduction in Australia in 1994, it has become the most widely used weight control surgery in the country, with more than 12,000 procedures performed in Australia in 2008 alone.

Why get gastric banding?

Gastric banding is a surgery to help morbidly obese patients lose weight. Obesity is known to increase the likelihood of physical and psychological illness, as well as placing overweight patients as the risk of heart disease, diabetes, high blood pressure, high cholesterol, heart attacks, sleep apnoea, depression and osteoathritis.

Who needs gastric banding?

According to guidelines from the National Health and Medical Research Council (NHMRC), morbidly obese or overweight patients over 18 years old with a Body Mass Index (BMI) of 40 or more are eligible for gastric banding.

Those who have a BMI of 35+ may be considered if they also have medical issues including heart disease, diabetes, high blood pressure, high cholesterol or severe arthritis.

The benefits of gastric banding

The benefit of gastric banding is that the smaller capacity for solid food means the person feels full more quickly. Food in the pouch is digested more slowly so the sense of 'fullness' can last longer after meals.

Studies have shown that gastric banding causes an average weight loss of 23kg at 2 years, and 43kg at 5 years.

Laparoscopic banding surgery is considered the safest of all types of weight-reduction surgeries, and patients only need be hospitalised for 24hours.

Studies conducted two years after the laparoscopic banding procedure showed improvements in:

  • blood pressure
  • cholesterol
  • asthma
  • diabetes
  • gastro-oesophageal reflux
  • heart falure
  • sleep apnoea
  • depression
  • infertility
  • blood clots

Is gastric banding covered by health insurance?

Gastric banding is a procedure that health funds will cover, providing it is deemed 'medically necessary' in a referral or letter from your doctor. However, it is not legally required for health funds to show gastric banding coverage in their Standard Information Statements, so it's not always easy to tell if this procedure is covered by your health insurance policy.

If the health funds' Standard Information Statement for a policy says there are restrictions or exclusions on 'other services (see insurer for detail)', it means that more services, other than the ones listed in the SIS, are restricted in some way, and this could include gastric banding. To find out for sure, the best option is to call the health fund directly and ask which of their policies include this feature.

How much will gastric banding cost?

If you have appropriate private health insurance (that is, a policy that includes cover for gastric banding), your health fund will pay costs towards a gastric banding procedure. However there will usually be a gap due to the difference in doctors' fees and the Medical Benefits Schedule for this procedure. The out-of-pocket expense for those with private health insurance is typically between $3,000 and $5,000. Without health insurance, the cost could be as high as $17,000.

Generally your clinic fee will cover all aspects related to your gastric banding surgery, as well as all associated aftercare and support.

You should check with your clinic to ensure that your costs include:

  • surgeon, anaesthetist, assistant surgeon
  • band check-ups (these are usually done monthly until you reach your goal weight, and then usually once to twice a year)
  • band adjustments
  • support such as: consultations by a psychologist, dietitian and nutritionist

Which health funds cover gastric banding?

Here for your convenience, we've listed moneytime's participating health funds and which of their health insurance policies cover gastric banding.

GMHBA
Gastric banding is covered under Gold Plus Hospital, Gold Hospital, Silver Plus Hospital, Silver Hospital and Silver packages. It is not covered under Bronze hospital or the Bronze package.

HCF
Gastric banding is covered by Top Plus, Hospital Savings, Hospital Advanced Savings and Fit and Free. A limited benefit only is payable for gastric banding under Young Singles and Couples Cover.

Peoplecare
Gastric banding is covered under hospital policies unless it is a restricted item. Please refer to the health fund for further information.

Please note: This information is provided as a general guide only, and should not be used as a substitute for advice provided by a medical professional or your health fund. We highly recommend you consult a doctor if you are concerned about your health, and speak with your health fund for specific health insurance-related queries.

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