I also had to pay out of pocket, so I chose to go to Mexico. I used Dr. Alverez, I found him through the internet www.endobariatric.com. My cost was $6,999, that included everything but airfare. Everything went perfectly! The Dr. and staff were wonderful, I do not regret it at all. The hospital was very outdated, but very clean. The hospital was located less than a mile across the border and I did not need a passport only my birth cirtificate and photo ID. Hope this helps! Kathy