Paying for Bariatric Surgery

Naturally, a very important consideration for all of our patients is the cost of bariatric surgery and how they will pay. To be sure, surgery is not a cheap option, however when accounting for the cost of obesity in United States (which has been estimated at upwards of $4,000 per year in medical and food costs) in addition to the intangible health benefits, the financials become clearer. There are several ways that a patient may be able to pay for bariatric surgery if they qualify. Following, we will discussed the basics:

Insurance Options

Whether through private insurance, a corporate policy for or state or federal government plans (Medicare and Medicaid) most patients have some form of medical insurance coverage. However, having a medical insurance policy does not necessarily mean that bariatric surgery is covered. Indeed, many policies explicitly exclude bariatric surgery, while for others, it is included. This is typically determined on a policy by policy basis and may vary between policies at the same insurance company.

We therefore suggest, that every patient intending to use their policy call their insurance company to understand the benefits that they are entitled to. We will also perform a preliminary insurance verification before your first consultation in order to determine your benefits. Most insurance policies will require the patient to pay for some of their procedure. Depending on the specific policy, this will depend on many considerations including:

  • Deductible – this is the amount of money the patient is responsible for before their insurance kicks in. Deductibles can range from zero to several thousand dollars. Deductibles apply to some services and not to others. Typically, the deductible resets at the end of the year.
  • Co-pay – this is the amount that the patient is responsible for before each procedure. Typically, this represents a relatively small portion of the overall procedure cost
  • Coinsurance – typically represented in percentage form, this is the portion of the procedure’s negotiated cost that the patient is responsible for. Once again, depending on the policy, this rate can be anywhere from zero to 50% or more.

Lastly, it is important to remember that insurance companies may have bariatric surgery qualification criteria above and beyond our base requirements for bariatric surgery that may include:

  • A letter of necessity from primary care physician
  • Enrollment in and completion of a medical weight loss program prior to surgery
  • History of failed diet and exercise programs
  • Verification of comorbidities or diseases associated with obesity

Don’t forget that you may also have supplemental insurance policies that, with your primary policy, may cover additional costs of surgery.

A Note on Medicare

While Medicare does typically cover bariatric surgery for qualified patients, they do not have a preapproval process, unlike other private insurance companies. Medicare patients therefore will need to double and triple check the qualification criteria to ensure that they should in fact receive coverage. We will assist in this process.

Cash Pay Options

Patients whose insurance policies do not cover bariatric surgery and for those who do not have insurance there is the option to pay out-of-pocket for the procedure. Patients who do not qualify under their insurance companies requirements for surgery or who do not wait want to wait for their insurance company to approve their procedure may also pay cash to shorten the qualification process.

Typically, patients who are willing and able to pay cash for their procedure can speak to one of our hospitals and receive a special, lower cash pay rate that is inclusive of all services associated with their surgery and is significantly reduced from “retail” hospital pricing. Is important to remember that there are several charges that are typically billed separately. These include:

  • Preoperative exams and testing – paid to us and any testing facilities used for pre-op diagnostics
  • Surgeons fee – paid directly to SAMPA for the costs associated with surgery
  • Hospital fee – paid to the hospital for the operating room, hospital room and nursing staff
  • Anesthesia fee – paid directly to the anesthesiologist
  • Follow-up care fees – paid to the providers, including us, offering aftercare

Unless part of a single package negotiated with the hospital beforehand, these fees are set and billed by each individual provider.

Financing

Paying for an entire surgical procedure in cash is often beyond a patient’s stability and there are several options to assist you with putting together the necessary funds. There are several medical financing companies that specialize in surgical procedures such as bariatric surgery. Feel free to contact us to find out details. Rates and fees will vary, so please be mindful of the charges as well as your obligations over the term of the loan.

Some patients also use various loan products at their disposal such as home-equity lines of credit, credit cards and even borrowing from family members to finance their procedure. Once again, please be mindful of the obligations that you will be undertaking by doing so.

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