Insurance, Cash Pay and Financing

by Regi Schindler, BLIS CEO/President

BLIS is a highly specialized company exclusively focused on the cash-pay (vs. insurance pay) bariatric surgery market. This market is referred to as cash pay, private pay or self pay. All of these describe the process whereby a patient pays cash for their elective (or non-health insured bariatric).

BLIS is an acronym for Bundled Loan & Indemnity Solutions. This name reflects our specific focus on the two major obstacles facing the cash pay bariatric surgical patient: Namely the cost of paying for the surgery (loan) and the potential additional cost of paying for known surgically related complications (indemnity). BLIS?s mission is to increase access to bariatric surgery by helping to minimize these two obstacles for the cash pay patient.

BLIS works closely with select members of the bariatric surgery community and allows our client, the BLIS Surgeon, to provide you the cash pay patient, with a safety net of protection. This safety net is known as BLISCare, which allows your BLIS Surgeon to make the following commitment to you: If certain surgical complications occur within pre-determined time frames following your surgery, you will receive the medical care authorized by your surgeon at no additional cost to you.

Like all major surgery, bariatric surgery has known and sometimes costly medical complications. For the cash pay patient, these known complications can create extreme financial distress. All things being equal, wouldn?t you prefer to have your bariatric surgery performed by a quality surgeon who can protect you from the extra costs of these known surgical complications?

BLIS is working closely with ObesityHelp to provide the cash pay patient with accurate and complete information regarding known complications associated with bariatric surgery. We are the only organization which has independent, verifiable third party data that will demonstrate high quality bariatric surgical complications and the associated costs. In sharing this information with you, BLIS and ObesityHelp seek to help you recognize and value high quality bariatric surgery and the protections afforded you by your BLIS surgeon. 

Our hope is to provide you with insightful perspectives as you make the decision to pay cash for your bariatric surgery. This will be supported by a unique set of data and information on a range of topics concerning bariatric surgery, complications and the cash pay patient.

BLIS Background

While the reasons vary, the fact is that more and more patients opt to pay cash for their bariatric surgery. Some industry experts estimate that in 2007, as many as 30% of the bariatric surgical cases performed in the US were cash pay. Regardless of the reasons or numbers, there is a universal truth every cash pay patient confronts: He or she must accept the full financial responsibility for any and all subsequent medical care not included in the cost of original elective procedure. As a result, the cash pay patient faces a great deal of financial uncertainty as to their ultimate actual cost of the procedure.

People often fail to realize that each and every encounter with a medical professional involves an acceptance of financial responsibility for the entire medical bill. Requiring our signature on the ?assignment of benefits? form giving the medical provider the right to bill our health insurance is a required part of every medical appointment. We have become so accustomed to the process of ?assigning? our rights to the medical provider that we often forget that ultimate financially responsibility is ours, regardless of whatever health insurance may be available to us.

Should the patient have health insurance, (and the procedure, e.g., bariatric surgery is not specifically excluded) the health insurer is there to cover the subsequent bill and thus provide a safety net of protection.

However, for the cash pay patient, and the insured patient having an excluded procedure, there is no ?assignment? and therefore no safety net of protection. As a result the cash pay patient can find themselves facing additional medical bills. Not surprisingly, medical bills have become a leading cause of bankruptcy.

All surgeries contain risk of complications, with the rate/severity at which complications occur varying by type of surgical procedure and by individual surgeon. Bariatric surgery is generally considered to be a high-risk surgical procedure relative to other surgical procedures, (e.g., an appendectomy).

Historically, medical professionals discussed complications with their patients in terms of frequency. In other words, the percent of time a given complication occurred across a broad population of similarly performed surgical procedures. Typically, surgeons express their complication frequency in comparison to industry norms. Experienced bariatric surgeons have less frequent complication rates compared to industry norms and less experienced surgeons. That said, all bariatric surgeons, no matter how well trained or experienced, can and do have patients who experience surgical complications.

BLIS introduced a new dimension into this historical risk equation. This new element is the cost of care associated with the surgical complication. I think of this as ?severity?. In other words it is not enough to know the frequency at which a complication may occur, but also the additional cost of care when it does occur. After all, these subsequent costs ultimately become the financial responsibility of the cash pay patient.

BLIS has developed a unique set of data which evaluates not only the frequency at which a given event might occur, but also the cost of caring for the patient when the respective event occurs. Thus, in helping the cash pay patient understand both the frequency and severity of complications, BLIS strives to help the cash pay patient become a better-informed consumer.

People naturally understand risk when communicated in financial terms, since money is the common denominator across our society. In helping the BLIS surgeon incorporate protection from complication related medical bills, we believe we are helping the patient differentiate one surgeon from another in terms more readily understood.

Until now the additional cost of care element has not been a part of the decision making process, since this data has not been available. Only BLIS has this data and plans to share it with you the consumer, via a series of articles presented here on ObesityHelp.com. This information will concern the overall experience of BLIS regarding the payment of medical bills on behalf of BLIS surgeons and their cash pay bariatric patient and what this data will mean for you, the cash pay patient.

Next: The BLIS Bariatric Surgeon >>

This information has been provided by BLIS, Inc. To learn more about BLIS solutions, visit http://www.bliscompany.com/.