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What If My Insurance Doesn’t Cover Bariatric Surgery

piggy bank, calculator and stethoscope lie infront of a light blue backdrop

When patients think of surgery, the first thought that pops into their minds is the cost, and rightly so. Surgery is, by any measure, an expensive proposition. When it comes to semi-elective procedures like bariatric surgery, there may not be the immediate desire to pay out of pocket, unlike more urgent surgical needs where there’s simply no choice. As such, patients quickly look to their insurance company to see if bariatric surgery is covered. The sad truth is that many insurance companies have bariatric surgery exclusions in their policies, which may vary between policies, despite being under the same parent company. The result is often frustration when patients hear that friends or family members with the same insurance company have coverage while they may not.

However, the insurance landscape is very different today than even a decade ago. Patients have more options if their insurance does not cover bariatric surgery.

Checking Your Policy

The first and most important thing you need to do is call your insurance company to verify your benefits. When you contact our practice, we will do the same, but it is essential that you hear it directly from your insurance company as well. We also want you to write down any questions you may have about insurance, including what your estimated out-of-pocket expenses will be and what requirements you’ll be expected to meet. We will, of course, give you a good faith estimate on how much your insurance will pay and, ultimately, how much will be due out-of-pocket. Your insurance company can confirm that.

On the flip side, you may find out that you either don’t qualify for bariatric surgery under your insurance plan, that it may take six months or more before you will be approved for surgery, or that there is no coverage in the first place. In cases like these, it is essential that you call our office and speak to us about cash payment plans.

Cash Pay Has Become More Accessible in Recent Years

We’ve all noticed, especially with individual insurance plans, that our total out-of-pocket expenses and deductibles have risen consistently over the past several years. Today, some plans have $8,000, $10,000, or even $15,000 in deductibles before insurance starts to pay for anything, let alone bariatric surgery. These high deductible plans mean that the cost differential between insurance coverage and cash pay has narrowed. For example, Dr. Higa has worked with our hospital to offer a cash pay rate of $15,000. This includes the surgeon’s fee, anesthesia, an overnight stay, several pre-, and postoperative appointments, and preoperative needs.

As a bonus, when you pay cash for the procedure, you are not subject to the sometimes-onerous preoperative requirements from your insurance company. These can include six months of medically supervised weight loss, additional tests, and proof of failed diet and exercise programs. Ultimately, these requirements are typically formalities and do not change the outcome of surgery or your ultimate success with bariatric surgery.

Patients can also avail themselves of financing programs offered by third-party companies. Of course, you should speak to a qualified, trusted financial advisor to understand if the obligations associated with financing your bariatric procedure fit within your financial abilities.

Ultimately, the decision to have bariatric surgery is life-changing, and most patients usually arrive at this conclusion once they have exhausted other weight loss strategies. While insurance can help with the cost of bariatric surgery, new plans have become more expensive, precluding many patients from having life-changing surgery to help them feel better and improve their long-term health. Unfortunately, insurance companies have not made bariatric surgery easier to pursue, but Dr. Higa and the bariatric community, in general, have re-doubled their efforts to get access to more patients than ever before.

For more information on cash pay plans or to learn more about your insurance plan and the coverages it offers, we encourage you to call our office and speak to one of our helpful billing administrators. We also encourage you to watch an online seminar to learn more about the procedures that may be suitable for you before you come in for a consultation.