Bariatric Surgery Out-of-Pocket Planner

Estimate how much bariatric surgery will cost you out of pocket by applying plan coverage percentages, deductible balances, coinsurance, and your remaining out-of-pocket maximum. Add optional HSA or FSA funds to see the net cash you must bring to surgery while keeping tabs on uncovered charges and what the plan will cover.

Quoted bundled price for the bariatric surgery, including facility, anesthesia, and surgeon fees.
Percent of the sticker price your insurer recognizes as covered after medical-necessity approval.
Outstanding deductible you must meet before coinsurance applies for the plan year.
Percent of the allowed charges you pay after the deductible is met.
Optional — defaults to unlimited when blank. Enter your remaining annual out-of-pocket maximum before this surgery.
Optional — defaults to $0.00 when blank. Enter the tax-advantaged dollars you plan to apply to the bill.

Informational estimate only. Confirm covered amounts, network requirements, and benefit limits with your insurer and provider.

Examples

  • Example 1 — $28,000.00 surgery, 90% allowed, $1,500.00 deductible, 20% coinsurance, $6,500.00 out-of-pocket max, $2,500.00 HSA ⇒ Patient responsibility: $6,500.00 | Net cash after HSA/FSA: $4,000.00 | Plan pays: $21,500.00 | Deductible applied: $1,500.00 | Coinsurance owed: $2,200.00 | Uncovered charges: $2,800.00 | Remaining out-of-pocket cap: $0.00
  • Example 2 — $24,000.00 surgery, 100% allowed, $750.00 deductible, 10% coinsurance, unlimited cap ⇒ Patient responsibility: $3,075.00 | Net cash after HSA/FSA: $3,075.00 | Plan pays: $20,925.00 | Deductible applied: $750.00 | Coinsurance owed: $2,325.00 | Uncovered charges: $0.00 | Remaining out-of-pocket cap: Unlimited

FAQ

How do I include required nutrition or psychological visits?

Add their estimated cost into the procedure sticker price so the allowed percentage and cost sharing apply to the combined amount.

What if my plan only approves a portion of the surgeon fee?

Reduce the allowed coverage percentage to reflect the portion the insurer accepts and rerun the calculation to see the higher uncovered charges.

Can I model multiple surgeries in the same year?

Yes. Subtract amounts already applied to your out-of-pocket maximum before entering the remaining cap in the optional field so cumulative spending is captured.

Does the calculator account for HSA funds?

Yes. Enter expected HSA or FSA dollars in the optional field to see the net cash you need after tapping tax-advantaged savings.

Additional Information

  • Allowed percentage limits the portion of the sticker price the insurer recognizes as covered medical expense.
  • Deductible applies before coinsurance, and both amounts are limited by the remaining out-of-pocket maximum.
  • Optional HSA/FSA input subtracts tax-advantaged funds so you can plan the true cash outlay.
  • Uncovered charges stay outside the out-of-pocket maximum and remain fully the patient's responsibility.
  • Remaining out-of-pocket cap result displays either dollars left to hit the cap or "Unlimited" when no cap is provided.

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