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How To Obtain Surgery Without Health Insurance


To obtain surgery without health insurance:

Step One: Check to see if you qualify for Medicaid (Medi-cal in California), or if you can qualify. Once covered by Medicaid, you can get treatment immediately.

Step Two: Do what you can to get a second opinion from a medical professional other than a surgeon to determine whether you need surgery or whether other treatments are available.  

Step Three: Check around to find out if you can obtain the surgery for free or for low cost. For instance:

  • The doctor who gave you the diagnosis may know of specialists willing to take people without insurance. The doctor may even know of specialists who work for free.
  • Hospitals which receive funds from the federal government have to provide a certain amount of free or low cost services. This is known as Hill-Burton. The finance department in a hospital can tell you if Hill-Burton treatments are available. (The earlier in the year you ask, the more likely that such Hill-Burton will be available.)
  • A hospital may have money available to pay for procedures for people who fit their specific criteria. Again, a hospital's finance department can tell you about what, if anything, is available.
  • NOTE:  Preferably the free surgeon has an anesthesiologist who is also willing to do the same. Anesthesiologists are responsible for keeping you alseep and checking your vital signs during an operation.

Step Four: If you cannot get free surgery, consider negotiating with a surgeon both as to the amount of fee and the period of time over which the money has to be paid.

  • Start by doing your homework. Find out a fair price for the service you need in the geographic area in which you will receive the service. Keep in mind that prices vary by geographic area, and also by who is paying. For instance, there may be a different charge for people insured by different insurance companies, for people who are covered by government programs such as Medicare or Medicaid and for people who are not insured.
  • Following are methods to learn the price which can be a starting point for your negotiations:  
    • Check online. For example:
    • Find out what Medicare pays. 
      • The amount is usually less than a doctor's price for uninusred patients. Centers for Medicare and Medicaid Services (CMS) publishes Medicare's approved rate for 30 common procedures, listed for each county in the country. The list doesn't say what the price would be if you had insurance or are uninsured. 
      • In order to find the Medicare rate, you need to know the CPT Code (Current Procedural Terminology Code) -- the code number uniformly used for the procedure in question. Any doctor's office should be able to give you the code number if you describe the procedure (it helps to have the technical term for the procedure). Then go to offsite link . The page informs you that the CPT code is owned by the American Medical Association and you agree to use the code only for the described limited purposes. When you "accept" you automatically move to the Medicare Physician Fee Schedule. 
    • Call other doctors in your area and ask what they charge for the service or procedure for people in your situation. Ask what is the lowest they charge for the service you need - and who receives that charge (for example, the lowest fee may be for a person insured with a particular insurance company). While doctors are reluctant to give out this kind of information, it can't hurt to ask. 
  • Think about what you can afford to pay and when. The sooner the doctor thinks he or she will be paid, the more likely he or she will agree to a lower amount. If you can agree to pay whatever is due within 30 days of the agreement, you are likely to get the best deal. 
  • Only negotiate with a decision maker. 
    • The decision maker is generally the doctor. 
    • A decision maker may also be the doctor's office manager. 
    • Bookkeeping staff can provide inside information, but they seldom have authority to make a financial arrangement. 
  • Think about what to say to get a "yes". 
    • Consider whether there are circumstances other than your financial situation to use in the negotiation. For instance friends who are patients of the doctor or mutual friends or communities (such as belonging to the same church or association). 
    • At the least, explain your financial situation. If you've completed some financial planning tools such as a Budget or a Cash Flow Statement, use them - particularly if they show severe financial hardship. Keep in mind that if a deal is reached, you may be required to provide proof of your finances beyond a statement you create. Every creditor knows they can't get money if there's none there. 
  • It is best to have a rationale for a dollar amount you ask for. For example: Consider offering to pay:
    • The amount other doctors in your area charge
    • The amount Medicare pays or the amount that Medicare pays plus a small,reasonable amount, such as 10% of the price Medicare pays.
  • Consider suggesting a barter system where you pay off the remaining debt with services you provide to the doctor. It's a win-win situation: the doctor gets the services he or she needs and you get your bill paid off. If the doctor cannot use your services, perhaps you can barter your services to someone who needs them, who in turn can provide needed services to the doctor. For information about bartering, see Bartering 101..
  • Think about your negotiating strategy. When you negotiate, keep in mind the doctor's interests. In general, the doctor's interest is to get as much money for each operation as he or she can. At the same time, doctors understand economic realities. They also understand the value of good PR (public relations).  For additional information, see, How To Negotiate For A Lower Health Care Bill

At least one company pairs patients willing to pay up front with small hospitals willing to give discounts - sometimes very deep discounts (up to 80% on common procedures). offsite link.

Consider "Medical Tourism" - going to a different state or even outside the United States for the procedure, to an area with high quality medical care with lower costs than your area.

There are a variety of sources from which to obtain money to pay for your surgery, some you may have thought of and some that may be available because of your health condition. For information, see: How To Raise Money When You Need It

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