What does the cost of surgery include?

Occasionally on the boards I see people toss out a ballpark cost for WLS. Somewhere around $30,000 seems to be the estimate I see most often. It's probably hard to say... but when someone tosses out an estimate like this, what is this figure likely covering? Is it the cost of surgery alone, or does it cover preliminary testing and/or followup? Best guess anyone? or does anyone feel like sharing what their total costs were from consultation through to followup? Thanks.

and does anyone happen to know if there is a cost difference depending on whether you have insurance or not? i envision many conflicting scenarios here. A) is it hopeful to think that they may charge self-pay folks a little less since they're individuals and not companies? B) is it skeptical to think that they charge insurance companies a lot more because insurance companies have more money? C) is it skeptical to think that they charge insurance companies less because they know there is a better chance for approval whereas a patient might otherwise not be able to get it? D) i think way too freakin much.

Vicky, It's okay, and probably a very good thing that you may be thinking too much, since the more you think and ask, the more of an informed patient you become. As a self-pay patient myself, I'd guess that I put out between $20,000 and $25,000 out of pocket. Actually, my insurance company picked up the costs of most of my tests. The key here is to get the proper referrals from your primary care physician (PCP), and that the codes your PCP puts on the referral forms are not ones that reflect a need for the tests because of obesity/morbid obesity per se. If you have co-morbidities, such as diabetes, high blood pressure, heart issues, etc., these should be the issues reflected on your referral forms for the pre-operative tests. That should, ideally, limit your out of pocket expenses to the co-pays and/or any deductibles provided for in your plan. The same is true with respect to prescriptions. In addition, and in my case, I've been working with a nutritionist who has significant experiences and background in understanding specific bariatric vitamin needs. While my consulting visits (pre- and post-op) have not been covered by insurance, she works with my surgeon and a local pharmacy (in Bethesda, MD) that compounds my vitamins to specifications she develops based on my bloodwork; the compounded vitamins are then prescribed through my surgeon. I have a co-pay of $35/month for the vitamins (used to be $10/month until 2005, when my employer's prescription plan changed a little); otherwise, the vitamins would be about $190/month. The surgeon's fees you will pay as a self-pay will be higher than what the surgeon agrees to accept from the health insurance company. That's why some surgeons do and do not participate with certain insurance companies, at least in part. I knew this up front, and simply accepted it as a fact of life. My surgeon's fees covered all pre-op consultation, and follow-up with him for six months post-op. It's okay for you to ask your surgeon whether he/she can package the overall pre- and post-op work in a single fee if you will be self-paying. The advantage to the surgeon also is that he/she will receive your payment up front, instead of having to deal with submitting and waiting for payment from the insurance company. (I also put as much as possible on my credit card to get frequent flyer miles for all of my costs.) My surgeon did tell me, however, that in Maryland, the hospitals must charge everyone the same price, regardless of whether the insurance company is paying or the patient. I do not know if this is the same for the anesthesiologist -- who is paid separately from the hospital. However, the surgery is relatively short, which should keep the costs for the operating room and anesthesiologist to a minimum. Most patients are in the hospital only one night. Hope this helps. Leesa

Yes, thanks, that helps a lot. $20,000 to $25,000 isn't quite as bad, and I pretty much already get a battery of tests through Joslin every year already. Last year I had a stress test, among other things. I do a panel of bloodwork and urinalysis every year, etc. If necessary, I can do it all there again and then some I'm sure. In fact, I'm due for a 24 hour and some bloodwork before I see my internist again in July. I am on a PPO, so I pay a little more out of pocket but have no PCP issues. I just make sure whoever I see takes UHC. So, perhaps I will at least be relieved of some prelim and Rx costs. Not a bad idea on the credit cards. Not bad at all. I tend to pay those off completely every month. Of course, I wouldn't be able to do that with $20K... but at least I would be at liberty to throw large chunks at them whenever possible. Guess I could do that with a bank loan too, but this definitely gives me an alternative. I think I could pay them off before the APR would cost me much more than a 3-4 year bank APR. I'm disciplined enough (learned the hard way many moons ago) not to get caught in CC traps. Shoot, even the amt I could afford to put down up front could go on my Amex toward points for a nice vacation. Can I pay my Amex with my Visa? Maybe I could get $30,000 worth of points. ;)

I think self-pay costs are higher than insurance company rates. Insurance companies pre-negotiate what they will pay a doctor for a given service. For example, I got a bill from the anesthesiologist for $1700. When I got the explanation of benefits from the insurance company, I saw they would only pay $800. When I called the insurance company, I was told not to worry about it, the price was pre-negotiated and I didn't owe anything.

See that's just rude. They should charge a self-pay what they accept from an insurance company. Heck, we have less money than the insurance companies. Do they assume someone is rich because they can pony up the money for surgery? They're in business to make a profit, and they're making a profit from insurance companies, so why not charge the poor self-paying individual the same. How annoying. Yeah, nothing I didn't already know really. But it's still annoying!

Hi Vicki, I was a self-pay, 25,500 paid for EVERYTHING from the minute I walked into the hospital on surgery day until I went home, including anything within a 30 day period, which thankgoodness I didn't need....also all my follow-up/routine app'ts for the REST OF MY LIFE are covered. I paid upfront and didn't get another bill for anything.... Barix, formerly Bariatric Treatment Center, did a great job of self-pay....there was NO open ended billing etc. Also, the dietian is part of that payment....she is available to me forever!! RAE

Sounds like a pretty good deal. Hope I can get that kind of setup wherever I end up going.

Thankfullly my insurance cover, roughly 90% of my surgery. The total bill came to about $15,000. I paided just over $1100 for my deductable. It covered my full stay at Bayview, doctors fees, etc. Amazingly too, they tracked everything while I was a patient and billed me accordingly (i.e. 2 binders, lotion, meds, etc.).