It’s a question we all ask (or at least think) when we are told we need a surgery. Unfortunately, getting an answer isn’t always that easy. Here are two reason why it’s hard to put a standard price sticker on your surgery.
1. What you pay can depend on your individual health insurance.
One thing that makes pricing more complicated in healthcare is the role of insurance. Private insurance providers (think Blue Cross Blue Shield and United Healthcare) negotiate their coverage fees directly with individual healthcare providers and facilities. That means if a surgery costs $2,000, one insurer may cover $1,000 while another only covers $800.
Now add in all of the individual health plans that people have. Do you have a co-pay? Have you already met some – or all – of your deductible? What is your maximum out-of-pocket? Is the facility in-network or out-of-network? With all of these other factors, how much you will end up paying for a surgery is truly unique to you.
At OSMS, our patient advocates are a great resource to help people who need surgery understand how much it will cost. They look at a patient’s insurance plan and determine if any out-of-pocket costs will remain after insurance benefits are applied. They also meet with patients to help them understand their insurance coverage, the out-of-pocket expenses they will be responsible for, and any financial resources that may be available.
Ultimately, the patient advocates want to help patients put together a plan for paying for their surgery in advance so that there isn’t “sticker shock” after it’s all done.
2. Sometimes a physician goes into surgery to do one thing and he ends up needing to repair something else too.
Let’s say you are having a knee scope. When the surgeon is performing this procedure, he discovers that you also have a torn meniscus that wasn’t detected prior to surgery. The surgeon isn’t going to ignore this new diagnosis. He’s going to fix the torn meniscus while you are already in surgery. Doing this may change the original cost of your surgery, but it will be significantly less expensive than having a completely separate surgery to repair the torn meniscus.
If you have questions or concerns about the cost of an upcoming or past surgery, please contact the business office at 920-430-8120.