While paying cash for your bariatric procedure will definitely save you the stress of having to go through various tests, counseling, proving that you have tried all other methods of weight loss, and often waiting for a minimum of six months prior to your procedure, paying cash also carries concerns that a weight loss surgery candidate should consider. Plus, when you pay for your surgery with cash, you get to choose exactly which surgeon you want to perform your bariatric surgery. There is no jumping through insurance hurdles and finding in-network carriers.
Before we look at the downside of paying cash for your bariatric procedure, lets look at the benefits.
The Benefits of Paying Cash
Paying cash does have a lot of benefits that should not be overlooked when considering how to pay for your bariatric surgery.
- You get to choose the surgeon that you want rather than an in-network provider.
- You get to have the surgery at the facility that you want rather than an insurance approved facility.
- You can have surgery as soon as there is an opening on the schedule.
- There is no risk of being turned down the last minute because of a coverage issue. Believe it or not, many people get a call from their insurance company a few days before surgery letting them know that they can’t cover the procedure for one reason or another.
The Risks of Paying Cash
The primary concern with paying cash for surgery is the risk of complications.While it is now rare to see deaths associated with bariatric surgery, complications do happen. Below is a list of a few of the complications associated with gastric surgery.
- Pulmonary Embolism
- Gastrointestinal Tract Leak
- Conversion to Open Procedure
- Bowel Obstruction
- Protein Deficiency, Vitamin and Mineral Deficiency
- Failure of Optimal Weight Loss and Weight Gain
- Too Much Weight Loss – Chronic Symptoms of Nausea, Vomiting, Abdominal Pain
- Body Image – Emotional Loss – Depression
- Nerve Problems
- Low Blood Sugars (Hypoglycemia)
- Kidney Failure
- Kidney Stones
- Complications from Anesthesia
- Other Complications
Insurance Might Not Cover Complications
Once you pay cash for your procedure and a complication arises your insurance company might not pay to have that complication fixed. A bowel obstruction can mean another surgery. Wound site infections are often covered by the hospital but wound dehiscence (the wound edges separating) are typically not covered. These ‘re-do’ procedures can cost upwards of $10,000. A leak can even cost more. This doesn’t mean that your insurance company won’t cover any future health issues that may present in the future as a possible result of surgery (i.e. nerve problems). But at the minimum, you should talk to your surgeon about complications and ask what happens if you have to re-operate.
Who Pays for Band Adjustments?
If you decided to get a Lap Band or Realize Band its important to note that fills may or may not be covered. Most bariatric surgeons will include this in the cost assuming that you are able to come back to them for follow-up fills. If you have your surgery out of your city to save money or to go to a preferred surgeon you may end up having to pay anywhere from $200 to $1000 per fill.
During your first year after the procedure you may have to get your band adjusted five times before finding the proper fill level that will produce enough weight loss while also allowing you to eat. This is especially true for those patients who opted to go for a cheaper procedure in Mexico or India. Gastric sleeves or the sleeve gastrectomy procedure has become popular for cash pay patients. Gastric bypass can cost $25k for cash pay patients. Gastric sleeves cost between $10k and $18k and may produce results better than gastric banding without the need to see the doctor for follow-up fills.
Even if you don’t have a Lap Band and need adjustments, you will still need to see your bariatric surgeon on a regular basis for the first year after surgery. The first month after surgery you will typically see your surgeon to check-in and every 3 to 6 months thereafter for the first year. Most of the time these appointments are included in your cash fee but ask in advance. Its not fun to pay $150 every time you need to see your surgeon after surgery.
The Benefit Of Using Insurance
Aside from saving money, there are some benefits to having your insurance company pay for your procedure.
- It takes about 6 months for approval. How is this good?
- It gives you time to prepare. Bariatric surgery is a major lifestyle change. If you decide today to have surgery and have surgery next week, you won’t be prepared to make the necessary after surgery changes that lead to success.
- Its a lot of work to get approved. The appointments, tests and paperwork are too much.
- This can also be good. If you put in the work to get approved you are more likely to put in the work after surgery necessary for success.
- Complications are covered.
- Follow-up appointments are typically covered.
- There is some re-assurance knowing that the surgeon is ‘approved’ by your carrier. Frankly, this does not have anything to do with surgeon skill but it does make some people worry less about their choice of surgeon.
So is Cash Pay Better?
Cash pay patients definitely have more options regarding the type of procedures they can choose from (cash pay patients can choose procedures that insurance companies consider experimental), location of surgery, and surgeon. Most of us do not have an extra $20k available to pay for surgery. But if you do, consider all of the costs that may arise from paying cash for your bariatric procedure. Be prepared and always ask what is included when you pay cash for your surgery.
Dealing with insurance can be a nightmare, but more insurance companies are starting to realize that covering bariatric procedures is not only the right thing to do, but it also makes financial sense.