How to Pay For Surgery Costs That Insurance Won't Pay

If you don’t have insurance or your insurance will not pay for your surgery, there are ways to afford the health care you need.

Paying for surgery out-of-pocket, commonly known as self-paying, can be incredibly expensive. However, it may be worth considering, especially if you can negotiate reduced costs. You can also look into payment plans, cost-sharing programs, and government or charitable assistance.

This article explains how to pay for surgery without insurance. It includes tips for lowering bills, securing a payment plan, finding financial assistance, and more.

Close up of surgical tools and money
Tetra Images/Creative RF/Getty Images

Determine What You Owe

If you have exhausted your options with your health insurance, it may be time to start considering alternative methods of financing. All financing options require funds to be repaid, unlike insurance which takes care of the majority of the bill.

Be sure that the costs you are financing include all of the expected expenses, such as:

  • Surgeon’s bill
  • Cost of the surgical suite
  • Anesthesia expenses
  • Hospital care before and after surgery
  • Labs
  • Medications
  • X-rays and any other tests ordered
  • Visits required before and after the surgery

In addition, understand all the expenses before the procedure takes place. You do not want to have a rude awakening when your first bill arrives and your interest rate or payment is much higher than you expected.

You will also need to plan for any contingencies, like complications, which may elevate the total cost of your care.

Billing errors are more common than you might think. When you receive a medical bill, inspect it closely, and don't be afraid to ask for an itemized bill if something seems off. You can always contact your provider if you have questions about the items on your bill.

Work With the Billing Department

Resist the temptation to ignore calls from the hospital's collection department. These individuals can work with you, help you set up a payment plan, and have the power to reduce the total amount of money you owe.

Prices negotiated by insurers can be much less than what out-of-pocket payers are billed. If you are paying out of pocket, you can ask the collections specialist to let you pay the same rate that insurance companies have negotiated for the same procedure.

The 2019 Affordable Care Act requires insurers to publicly disclose the rates they pay for medical procedures. The data should be published on the insurer's website, but the files can be quite large, complex, and difficult to interpret on your own.

Nevertheless, collections agents must also be honest about insurer-negotiated prices. When speaking with an agent, ask to pay the lowest price negotiated by insurers. This is a reasonable request and is often honored, especially if negotiated in advance. Get this agreement in writing.

If you need an extremely expensive surgery, such as an organ transplant, it will be more challenging.

Try to Reduce Your Fees

Before you try to figure out how to pay without insurance, try to determine if there are ways to decrease costs before you have the procedure.

The people who work in billing will be most likely to know how to save you money. They also will know about programs for people with financial difficulties. 

Choose In-Network Providers

As a general rule, providers in your insurance network will cost less, and providers in your network will cost more.

That means everyone providing care, from the anesthesiologist to the surgeon, from the hospital to the pharmacy, needs to be in-network if you have insurance. You will have a better rate, even if your insurance company isn't picking up the tab.

In some cases using a surgery center instead of a hospital can result in thousands of dollars saved.

Negotiate Better Rates

Call the surgeon, surgery center, anesthesia provider, and anyone else providing your care and explain that you will be paying out of pocket, so you would like to have the best rate they offer. If you are pleasant, persistent, and explain your situation, you may be shocked at how much the potential bill can change.

In some instances, cash payers may actually pay less for a procedure than people who pay the price negotiated between hospital and insurer. If you plan to pay out of pocket, ask the billing specialist to disclose both the "cash price" and the price negotiated by insurers. You have every right to ask for the lower price.

Questions to Ask Before Financing

Before you finance your surgery, ask yourself these important questions:

  • How long will you have to repay the loan?
  • What will the payments be on the debt?
  • Will you be able to manage the payments or will you be struggling to pay your bills on time?
  • Will you be paying your credit cards off forever because you will be unable to make a payment larger than the minimum?
  • What will you do if the cost of surgery is higher than estimated by your surgeon?
  • Will you be driven into bankruptcy if the cost, and therefore the payments, are underestimated?
  • Will you be able to afford the prescription medication you require after surgery if you are paying your credit card bill?
  • Will you be unable to save for your future needs if you are paying for your surgery?

If the answer to any of these questions concerns you, try to find a solution for it before your procedure. Although they can be heavy questions to consider, fully understanding your situation can help you communicate with lenders, insurers, and providers about realistic payment plans.

Borrow From Retirement Savings

Your 401k or 403b retirement plan may allow you to take a loan against the funds that you have already saved without a penalty. These plans differ from employer to employer, but most will allow you to withdraw 50% of your vested balance—up to $50,000—for healthcare expenses.

The length of time allowed for repayment varies. But, if you leave your place of employment before you repay the money, there can be substantial tax penalties. You will lose the interest you would have earned on the money you withdraw, but you will not be paying interest on the loan as you would with traditional borrowing.

If you have a Roth IRA, you may be able to access the funds to pay for your surgery. Typically, a Roth IRA is not managed by employers, but by individual investors, so you may have to do your own research. Start by calling the customer service number for your fund and inquire about taking money out of the IRA before retirement age.

Use Your Savings

While spending your life savings on something like surgery is not ideal, if the surgery will improve your quality of life, it may be money very well spent.

Depending ​on your credit and income, you may want to borrow the money from an outside source and keep your savings easily accessible.

The downside to a loan is that it will result in interest being charged. However, it may be worth the extra money paid in interest to maintain the security of a nest egg or emergency fund.

This is especially true if you need the money during your rehabilitation, or if you are unable to work.

Use Your Home Equity

Home equity loans are borrowed against the value of your home that is greater than the balance of your mortgage. For example, if your home is currently worth $300,000, but you owe only $200,000 to the bank, you may be able to borrow against the $100,000 in equity.

It is typically easier to get this type of loan than an unsecured loan because the house is your collateral. This type of loan also provides a tax break as the interest is tax-deductible like a standard mortgage.​

Keep in mind that if you are unable to make the payments on a home equity loan, the consequences can be dire. Failure to pay the loan back can result in foreclosure and eviction from your home.

Take Out an Unsecured Loan

An unsecured loan is a loan that is not secured with property that you own. It is a loan based on your credit and income and does not use collateral to guarantee the loan. Credit cards are one type of unsecured loan but there are other types available.

The bank or loan company will determine how much you may borrow and at what rate, as well as the terms of repayment. This type of loan is harder to get than a home equity loan and typically has a higher interest rate.

Your surgeon may also be affiliated with a loan program. If you qualify for this type of loan, be sure to compare interest rates with all other possible loaners.

Pay close attention to the interest rate and compare it to your other options. If you have a credit card that offers a very low rate, the credit card may actually be a more attractive option.

Arrange a Payment Plan

Some surgeons and hospitals may offer a payment plan for their services, but the plan is a monthly pre-payment plan that is finished by the time surgery occurs.

Monthly payments, even if they are not large, are more attractive to the billing department than no payments, and it may keep the debt from appearing on your credit report as a negative account.

Payment plans are most commonly offered for unplanned, emergency surgeries, or when the surgery is routinely paid for by the patient, instead of an insurance company.

A hysterectomy is almost universally covered by insurance, so surgeons who specialize in hysterectomy might not offer a payment plan. Conversely, plastic surgery is almost never paid for by insurance, so the surgeon would be more likely to know about self-pay options.

In some cases, payment plans are a formal agreement that you will make monthly payments to pay for the expenses of your surgery. In other cases, the payment plan is a loan, but the hospital or surgeon is involved in the financial arrangements.

Consider Surgery Outside the U.S.

Known as medical tourism, surgery in other countries is almost always less expensive. In some cases, surgeons were trained in outstanding American facilities, and have the same, or better, training than surgeons practicing in the United States.

Medical tourism is not to be taken lightly and should be thoroughly investigated. In addition to the surgeon’s credentials, which should be verified, the facility in which you would recover needs to be researched as well.

While it is imperative that the surgeon be highly skilled, the person who cares for you during your recovery is equally important. They must be able to identify any warning signs or complications that may occur and notify your surgeon.

Some insurance companies are even paying for medical tourism for necessary procedures, as the cost to them is dramatically less. You would need to discuss this with your insurance company representatives to get more information.

Use Credit Cards Cautiously

With the sky-high interest rates that credit cards charge, this option is not normally an attractive one, but a last resort. Some credit cards charge as much as 22% interest, a staggering amount when borrowing the large sums needed for surgery.

In some cases, the rate of interest is significantly lower than that, providing a much more attractive option for paying for surgery. Your credit card statement will clearly state your annual interest rate, but it may be possible to have the rate lowered, depending on the company.

If you have exhausted your options and must use credit cards, determine what your payments will be after you pay for the surgery. If you have multiple cards, use the card with the lowest interest rate.

Switch Insurance

If your current insurance has an exclusion for your surgery, but a different insurance plan will pay for the procedure, you may want to consider changing insurance plans.

If you are married and your insurance won’t pay for the surgery, but your spouse’s will, you could potentially save thousands of dollars by switching to your spouse’s insurance.

Many companies wait until January to make alterations to their insurance policy. Other insurers may make changes during a different part of the year. Be sure to inquire about any upcoming changes.

When the new policy begins, your coverage may have been changed or moved to a new insurance provider. In these situations, it pays to investigate what the new company or policy provides.

You may find that you need to schedule your surgery before the change in order to save money, or you may be wise to wait, depending on the changes in coverage and the copay amount.

Health Sharing Programs

Health sharing programs (HSPs), also known as cost-sharing organizations or health care sharing ministries (HCSM), are programs in which members help pay one another's medical bills.

HSPs can be a budget-friendly alternative to insurance. Typically, members pay a monthly fee to cover expenses for other members.

There are some cons to health sharing programs. Unlike insurance providers, HSPs do not have to comply with the Affordable Care Act, so they do not guarantee payment for bills.

Also, most HSPs set a monthly, annual, and/or lifetime limit on coverage. For example, the HSCM called Altrua Ministries sets a $150,000 lifetime coverage limit.

Furthermore, with the exception of certain emergency surgeries, Altrua does not cover outpatient surgery within the first 90 days of membership.

If you need a major surgery or a series of surgeries, or if you have a chronic condition that could lead to more surgeries down the line, a health sharing program is probably not the best choice.

Government or Charitable Assistance

Financial assistance programs, sometimes called "charity care," provide free or discounted health care to people who need help paying their medical bills. The Affordable Care Act requires hospitals with 501(c)(3) nonprofit status to have programs to provide this care.

Such hospitals are required to publicize their financial assistance program both at the hospital and on the hospital's website. The hospital must also be transparent about eligibility criteria.

As an example, the Hospital Care Assurance Program in the state of Ohio offers help with unpaid medical bills to Ohioans who do not qualify for Medicaid coverage, and who are at or below the federal poverty level.

Take note that some financial assistance applications may require you to prove that you have applied for Medicaid and were denied. Contact the hospital directly to learn about your eligibility.

Other resources that can help you find government or charitable assistance programs include:

  • Veterans Health Administration: If you are a military veteran, you should have several health coverage options by law. Visit the Veterans Health Administration website to review your eligibility.
  • State insurance department: Research or contact your state's Department of Insurance if you have concerns about your insurance or Medicare, or if you have an insurance complaint that you think should be investigated.
  • Consumer Financial Protection Bureau: This government bureau's job is to protect consumers from financial abuse. It is a great resource for those who have complaints or concerns about lenders, debt collectors, banks, or other financial entities.

Summary

To reduce the costs of surgery, you'll need to be clear about what you are paying for. Billing errors are common, so it may help to ask for itemized bills. If you are insured, get all tests and procedures done at in-network providers. Don't shy away from talking to collections specialists. Believe it or not, they're there to help. Hospitals should be transparent about the cost for "cash payers" versus those with insurance, and you may be able to pay whichever is lowest. Many hospitals offer financial assistance programs; contact the hospital directly to see if you are eligible.

17 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Jennifer Whitlock, RN, MSN, FN
Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. She has experience in primary care and hospital medicine.