Healthcare today is a complex environment, and many states, regions and hospitals have been having problems in being solvent. Insurance co-payments have decreased, and the contract made with the physician depends on market leverage. We address contract problems in bariatric surgery and discuss how to try to divide bariatric surgery from general surgery practice, to get better insurance reimbursement. Creating leverage is also important: 1) how to attract new patients, and 2) how to add additional procedures, when necessary, to the initial bariatric surgery scheduled. Leverage can also be created by offering additional services, such as access to a dietician and exercise programs. By offering a variety of services, this will enhance not only the quality of care provided, but also the number of patients who will take advantage of your services, including bariatric surgery.