I am trying to get approval through my insurance company (BCBS) for gastric bypass. I'm wondering if there is a benefit to skipping the insurance route and paying for my own doctor instead. Will I get a better choice of doctors, or will the doctor be able to offer better care to a self-pay patient?
Gastric Bypass - Self-Pay Patient Vs. Insurance
Doctor Answers (7)
Self pay vs. insurance for gastric bypass
All patients are treating with the utmost care and respect. Self pay patients can sometimes get the surgery sooner based on the type of insurance they have. As far as being exposed to risk of complications with self pay, there is a company called Bliss which sells insurance to patients to protect them against complications and the associated costs.
Self-Pay vs. Insurance
The only advantage of going the cash-pay route is that everything will be expedited. You won't have to wait for BCBS to authorize your surgery; you may not need a psych evaluation, and you definitely won't need to go through a 6-12 month period of professionally supervised diet and exercise. Every state's BCBS is different, however. In Michigan, where I practice, BCBS is fairly enlightened, and there is generally very little delay in getting surgery scheduled.
If you came to me, I would advise you to let my office try to get authorization from your insurance company. We would then advise which, if any, obstacles you would have to overcome to get them to pay for the surgery. At that point you could make an informed choice as to how to proceed.
Will I get a better choice of Plastic Surgeons as a self-pay patient?
Regarding: "Gastric Bypass - Self-Pay Patient Vs. Insurance
I am trying to get approval through my insurance company (BCBS) for gastric bypass. I'm wondering if there is a benefit to skipping the insurance route and paying for my own doctor instead. Will I get a better choice of doctors, or will the doctor be able to offer better care to a self-pay patient?"
I agree with 99% of Dr. Kavali's well thought out comments but I PARTIALLY disagree with this one.
Let's for a moment leave Medicine out of it and consider life realities instead. WHO gets the best seats at a restaurant, those who are unknown or those who hare known to spend and tip well? Who gets to buy stock IPO's at the best prices small investors or large firms who pay large sums of cash? Who gets to buy expensive cars out of a showroom the average guy who walks in with his trade in and finance all in line or the high roller who is prepared to pay cash for the car?
Insurance companies are a HUGE hassle to their insured but also to the doctors who have to deal with them. Doctors spend huge amounts of time dealing with insurance companies. For this reason, busy surgeons have trimmed the numbers of insurance companies they have to deal with by no longer working with the worst offenders. As a result, your choice of Plastic surgeons IS SERIOUSLY limited if you want your insurer to pay for your operation. Instead of having your pick of ALL the surgeons in your area you will be limited to those who work with that insurance plan and who are willing to brave the field of hurdles put before them to get an operation approved and then paid for fairly.
The post-operative care SHOULD be the same.
Dr. Peter Aldea
You might also like...
Insurance vs cash pay for bariatric surgery
You'll get the same care no matter how you pay for your bariatric surgery: cash or insurance. And you may find that the same surgeon will accept either cash or your insurance plan. The only caveat is if your insurance is an HMO-plan and your desired surgeon isn't part of that HMO. In that case, cash would be you only option for seeing that surgeon.
If your insurance will cover your surgery, then I would go that route. Just meet with a couple of surgeons before you decide. Good luck!
Self Pay vs Insurance for Bariatric surgery
There is no difference in care between self pay and insurance for bariatric surgery. Self pays allows to have surgery sooner rather lhan having to go through a waiting period as mandated by your specific insuracne policy. Cash pay allows you to pick the doctor you want. The issue with cash pay is that you are financially exposed if there is a complication with the surgery.
Obtaining bariatric surgery through self-pay versus insurance
The care that a patient receives whether the insurance company is paying or whether the patient is paying is absolutely the same. The only difference is that the date of surgery would be expedited. Some insurance companies require six months of medically supervised diet which will delay the surgery date. If the patient pays for the surgery then of course the surgery date would be expedited. However, the patient must be aware that if there is a complication (god forbid), then they are responsible for paying for possible intensive care unit costs, diagnostic testing costs, and possible further surgery to repair the complication. Of course complications are extremely rare, however they can occur and they can be very costly and the self-pay patient would be responsible for that.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.