You’ve made the life-changing decision to pursue bariatric surgery, and now you’re weighing the costs: should you go through your insurance, or self-pay? For some patients, the decision is easy (for instance, if their insurance provider doesn’t offer bariatric surgery coverage) while for others it can be difficult. Let’s walk through whether going through insurance or doing self-pay is right for you.
Bariatric Surgery and Insurance Providers
First, it’s important to note that insurance will often pay for bariatric surgery…but often is the key word. If you’re on the Connect for Health Colorado Exchange, you should have bariatric benefits, because exchange plans in Colorado are now required to uniformly support these benefits. That said, some employers will negotiate away bariatric surgery coverage in exchange for reduced premiums, so it’s still important to check with your insurance to make sure that you are covered.
Some insurers are also known to exclude bariatric surgery; and this happens far more often than it should. For gastric bypass surgery, for instance, almost half of prior authorizations in some areas are not approved. Insurers also sometimes only cover specific surgeries, or only reimburse for certain expenses related to weight loss surgery. For these reasons it is important to get a copy of your specific policy from your HR department and understand what is included and what is not.
Even if your insurance approves your weight loss surgery, you’ll still be responsible for your deductible and the copay of the surgery. These costs can be substantially less than the cost of weight loss surgery for some plans, and many of our patients choose to pay with insurance because of this lower cost; but it’s still important to be aware of these costs going in. Paying for weight loss surgery through insurance can still have a significant cost.
Insurance companies also generally impose specific conditions on weight loss surgery. For example, most insurance companies mandate a 3-6 month period between a patient’s initial consultation with their surgeon and their final surgery. Many insurers require participation in a medically supervised weight loss program. These are ways that insurance companies try to keep their costs down, but they can impose rigid limits on patients. Many of our patients do choose to pay with insurance and have an excellent experience; but others prefer self-pay, even if they have bariatric benefits, because self-pay offers more freedom and flexibility in this important decision.
Can I Self-Pay For Bariatric Surgery If I Have Insurance?
Yes, you can self-pay for bariatric surgery even if you have insurance. Self-pay can be more expensive, but it can also offer greater freedom and flexibility for patients making this life-changing decision.
Should I Self-Pay Even If I Have Insurance Coverage?
If your insurance doesn’t cover weight loss surgery, then self-pay is a great option. At the Bariatric and Metabolic Center of Colorado, we have transparent and inclusive pricing for each weight loss surgery, and these prices are some of the lowest in Colorado…often by thousands of dollars. You can see our self-pay weight loss surgery pricing here. It is also important to remember that value is not simply equal to low cost but also to how much you get for what you pay. At the Bariatric and Metabolic Center of Colorado, we also seek to maximize your value by including a broad range of education, behavior transformation, and the combined services that you will need to complete your surgery without surprising or hidden fees.
Even if you have bariatric coverage, though, you might still elect to self-pay rather than go through insurance. Here are some of the benefits that cash-pay patients receive:
1) You have more freedom to choose your bariatric surgeon. Insurance providers sometimes require you to pick a surgeon and hospital that are in your network, but this might not be the right surgeon or program for you. Getting bariatric surgery is one of the most vital decisions of your life, and your decision of who should perform the surgery is profoundly important. Many cash-pay patients pay this way because they want to make this decision themselves, rather than feeling limited to a list of surgeons approved by their insurance provider.
2) You have more freedom to choose your surgery. As mentioned, some insurance providers do unfortunately deny weight loss surgery claims; and sometimes they will only approve a specific bariatric surgery or may exclude a specific bariatric surgery. The fact is that different weight loss surgeries are right for different people; for example, if you suffer from a BMI >50, then the duodenal switch surgery represents your best opportunity for lasting weight loss. Ultimately, the decision of which weight loss surgery you undergo should be made by you and your surgeon, and not by an insurance company.
3) You can get surgery faster. Many insurance companies make patients jump through specific hoops to get surgery, such as participation in a medically supervised weight loss program mandated by the insurance firm. Insurance companies also require a 3-6 month waiting period between your first appointment with your surgeon and your actual surgery. For some patients, this can feel too slow. If you know that you’re ready to lose the weight and keep it off and transform your quality of life, then doing self-pay means you can schedule your weight loss surgery much more quickly…often within just a few weeks of meeting your surgeon for the first time.
4) You don’t have to worry about red tape. For many patients, the approval process to have their insurance cover their surgery can be long and frustrating, and there is the risk that the insurance company will ultimately deny your claim. Some patients don’t want to deal with this hassle or risk. If you want a clearer and faster path to weight loss surgery, then self-pay may be right for you.
5) The cost can occasionally be less for self-pay than for insurance. This is because some insurance plans have very high deductibles and copays for bariatric surgery, both of which will need to be paid out of pocket. Additionally, many bariatric surgery clinics offer discounts for cash-pay patients because self-pay involves less overhead for the clinic.
Bariatric Surgery Self-Pay Options
Once you’ve made the decision to self-pay for weight loss surgery, the cost of financing your surgery can seem daunting. But the truth is that there are lots of bariatric surgery self-pay options. Some of our patients pull from savings. Others take out a loan, so that the cost of weight loss surgery is spread out over (say) 60 months. Others have sold their second car or even refinanced their homes in order to make sure they can afford surgery.
The truth is that weight loss surgery is one of the most powerful things you can do for yourself. It can transform your life, and help you have the energy to go on hikes and play with your kids (or grandkids). From a purely dollars-and-cents perspective, reclaiming your health and your quality of life is the best investment you can make. Obesity is a disease, and like any disease, it takes an immense toll. On average, adults suffering from obesity pay 81 percent more for healthcare, which adds up rapidly. That cost comes in the form of prescription drugs, medical bills, higher health insurance premiums, and many other costs.
Don’t ask yourself, “Can I pay for surgery?” Instead, if you’re truly committed to losing the weight and keeping it off, reframe the question to, “How can I pay for surgery?”
Taking the Next Step On Your Weight Loss Journey
We understand that the process of self-paying for bariatric surgery can feel overwhelming, and we’re here to help. If you’re considering self-paying for your bariatric surgery and want to know more about the process involved, we encourage you to schedule a bariatric assessment with us.
Our patients routinely say that surgery was the best decision they ever made.
“I feel like I have won the lottery and have been given a second chance in life! March 25, 2014, was the first day of the rest of my new life and I can’t even start to express in words how grateful I am.”—Rochelle Goforth, patient.
If you’re suffering, don’t wait. Call our Denver office today.