Approaching Surgery When You Have No Insurance

October 9, 2016

What do you do if you need surgery and have no insurance? Who will do the surgery? How much will it cost? This post explains some of the basics that will help you make a good decision.

Let's first understand that, while we generally see it as positive, modern health insurance is not always so. Modern health insurance regularly takes increasing amounts of your money, restricts your choice of surgeons, and may impose bureaucratic burdens on your path to treatment. Modern health insurance may differ with your doctor and you about the necessity of your surgery, in which case it may refuse to apply your money to your care. For example, health insurance often demands that you get pre-certifications before you have surgery; in our experience, insurance companies usually offer nonspecific non-commitments regarding your specific case, which requires more effort by you.

Depending upon your financial and medical circumstances, it can actually be liberating to go direct, without an opinionated and bureaucratic third party holding onto your money. This is as true for direct surgical care (DSC) as it is with direct primary care (DPC). If you are uninsured and shopping for your surgery directly, there are some things you should keep in mind:

1) Quality. This is surgery, not a new pair of socks. You can't undo it if you don't like the result. Given the high stakes around surgery, the first thing to look for is quality. You want the right surgeon. We address the issue of surgeon quality in more detail here. Getting at surgeon quality as a practical matter can be complicated and the knee-jerk methods can be invalid. For example, board certification tells you nothing about which surgeon operates better. To help you refine your questions, have a look at the multi-step and relatively laborious way we qualify surgeons. You may want to adopt a similar approach.

2) Convenience. You may find a highly qualified surgeon in Timbuktu, but getting to him/her won't be that easy. So location may be an important element of your convenience. There's more. One of the inconvenient aspects of insurance is the financial and administrative hassle. If you are uninsured, you can be free of that hassle. Get clear costs (see below) and make sure you're not getting an estimate. Get a flat fee that includes all personnel and also ancillary procedures. Click here to read more about ancillary procedure surprises.

3) Cost. Surgery is about more than a surgeon. It involves anesthesia, facilities, and often much more. Depending upon which procedure you need, make sure you think through and account for all the different components of the service you'll need. We've linked itemized package descriptions on the top right of every procedure page. If you like, download and use them as a guide. Here is an example for knee replacement.

4) Choice. If you're lucky and work at it, you'll find more than one choice. Be sure you do an apples-to-apples comparison before you select. So if one surgery package includes physical therapy, make sure the other choice also does. Then, once you're sure the packages are uniformly defined, compare the surgeons, locations, and costs. We fine spreadsheets useful for this purpose. Here is a template that might help you that compares three vision correction packages.

We're all used to thinking about insurance as a requirement for surgery, but this is not the case. You can have surgery without insurance. Read how an uninsured woman with a kidney stone shopped for her surgery. See how she got the right surgeon, a flat-fee comprehensive surgery package, cost reduction, added financial peace of mind in the event of complications, and effective treatment, all close to home.

Use the points above to guide your actions and make contact with us if we can help you.

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