Alabama Bariatrics & Minimally Invasive Surgery

Bariatric Diet Orbera Gastric Band Sleeve Gastrectomy Gastric Bypass

W. Jay Suggs, MD, FACS, FASMBS
Huntsville & Decatur
Phone: (256) 274-4523
Fax: (256) 203-8791

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Contact Us

W. Jay Suggs, MD, FACS, FASMBS
Huntsville & Decatur
Phone: (256) 274-4523
Fax: (256) 203-8791
EMail: drsuggs@alabariatrics.com

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Healthcare Issues with Alabama Bariatrics - Why Won't Insurance Companies Pay for Something I Need?

no insurance cash pay

HUNTSVILLE, AL - I am writing this in the time of year when the government is non-stop spamming my phone, emails and other means of communication about signing up for a health insurance plan. It is an ugly, scary process that almost seems outright unnecessary given how little they are willing to cover. This time of year often leaves me pondering, why on Earth is it a contentious issue in the first place? Because I remember jokes about it being a political problem back in the 1990s. This was long before the Affordable Care Act was even a thought. It's almost like America has the worst track record when it comes to caring for its own population.

If we break down the most basic concept of insurance, a bunch of people pooling into a savings account for an emergency, why would they hesitate to pay out when that emergency happens? Why do doctors and dentists prefer to have their own payment plans than to deal with insurance companies? It is almost like a system that is meant to save lives is severely broken. How did we get here? So, this is an effort to understand the healthcare insurance system as we know it, and why it affects things like your bariatric surgery. 

Our Biggest Problem

It is no secret that people pay a lot to health insurance companies. In fact, the United States has consistently spent the most on healthcare every year. It is the largest private-sector industry with over $3.5 trillion dollars spent every year.  You would think that this would ensure quality performance for each person enrolled in health insurance, right? Except its the opposite. The United States ranks the worst among other first world countries in quality healthcare. But if we aren't paying for quality are we paying for quantity? Not necessarily. If anything we also have the highest rate for preventable deaths that range from obesity, disability, preventable diseases, lab accidents, and mortality rate from respiratory disease. So, why are we paying so much for so little? 

It boils down to a series of factors that range from understandable to outright absurd. For starters, the main issue is that health insurance in America, as we know it today, is a for-profit business model.

Profiteering and Health Insurance Woes

So, say if you need bariatric surgery because your life is on the line. You have done everything you can to lose the excess weight, and nothing is happening. Even the doctor you are seeing supports your decision and sees that you are doing everything right. Then the insurance company refuses to pay for any of it. Why are they punishing you for it? They aren't punishing you. They are rewarding their shareholders. Again. 

See, the main problem is the for-profit business model behind healthcare. Medium.com, a blog specifically about business, states quite plainly,

"American health insurance companies are for-profit organizations, their first priority is to generate profit for the shareholders, not provide healthcare. The only way they can stay profitable is by not serving their customers. You pay your premium every month, but when you get sick and need an expensive procedure, the company loses money. So denying you healthcare is in their best interests."

Insurance Pays as Little as Possible for Maximum Profit

This is probably screaming political bias to you by now. And I would not blame you for thinking that. But it's not just someone left-leaning saying it. A staunch right-leaning publication is saying the exact same thing. Contributor John C. Goodman, a man who unabashedly leans politically right, and is an expert in the medical insurance topic, knows that this is a problem too.

"A health plan that is good for sick people attracts more sick people and that is not in the self-interest of anyone who is in charge. Ironically, failing to meet all the needs of people who are sick can be profit-maximizing."

In other words, insurance companies aren't financially incentivized to pay large bills and treat people in emergencies. Instead, they try to pay for as little as possible by fronting the costs of small, day to day expenses and stick their patients with the big bills. Their company profits and both hospitals and patients are left in the lurch. 

What Do I Do to Cover my Surgery?

For starters, you and your medical provider, whether that is Alabama Bariatrics or any other medical company, needs to present a united front when submitting a claim. Research and provide data about how much it will cost. If you have the data about the short term versus long term financial burdens of bariatric surgery versus obesity, you can argue that you are saving the insurance company money in the long run. If that doesn't work, you can talk to the surgery provider about working on a flat in-house payment plan. The doctors will see more of the profit, and if you agree upon a fee in advance, you can at least get a more transparent rate about what you are paying for. 

If you are looking for weight loss surgery in Huntsville, AL at a reasonable rate with great results look us up at www.alabariatrics.com