Need surgery? How to figure out how much you’ll be on the hook for
You may have insurance or you may not. The cost of your surgery is going to come out of your pocket anyway, either directly or indirectly.
If you don’t have insurance, then the math is obvious. But sometimes people with insurance don’t realize the cost they’ll be obligated to pay — until the bill comes and it’s too late. At that point, you already bought it and you might owe thousands of dollars.
For example, maybe your surgery benefit is “co-insurance.” This means that you pay a percentage of surgery costs. If the surgery costs $25,000, then you might owe, say $5,000. That’s a big bill to get unexpectedly.
On the other hand, maybe you think you’re safe because your insurance has a max out-of-pocket and/or you’ve met your deductible. Don’t be misled.
Your insurance company isn’t going to lose money.
They add up all the costs for the year and divide by the number of insured people — with a little profit sprinkled on top. That’s how your premium is calculated. So when you and others like you get lots of over-priced care, your premium goes up. And up. And up.
Keep in mind medical bills are the biggest reason for bankruptcy in this country even amongst people who have insurance. If you need medical care, this is a true and present danger.
Here’s something many don’t realize: The cost of the same exact surgery can vary wildly. A knee replacement may cost as much as $47,000 in one surgery center and less than half that much across town.
And by the way, the most expensive places generally are the ones with not-so-great patient outcomes.
How’s that for backwards?
There’s a number of reasons why, but one of them is that the best surgery centers with the best outcomes do lots of surgeries. Volume matters. Volume also means that the surgery center is more efficient … so lower prices.
The semi-good news in all this? You can shop for surgeries.
It’s not easy, but there are resources you can tap into to figure out which surgery centers offer the best “bundled” pricing for the surgery you need. And the ones with the best pricing are often the highest quality, so it can, kind of, be a two-birds-with-one-stone endeavor.
Need some help ferreting out the price of your surgery or procedure? Here’s a directory of places you can look:
(This list is a work in progress. If you have resources to add, please comment and I’ll add.)
Some states have cost-compare resources:
Florida: https://pricing.floridahealthfinder.gov/
Maine: https://www.comparemaine.org
There are a few national search engines:
https://www.guroo.com/
https://clearhealthcosts.com/
Check out the American Hospital Directory for self-reported cost and quality information. Look for the specialty you need in the chart.
There are also surgery centers who publish their prices:
