Quick question: cost of outpatient surgery

[ahisma]

Quick question - can anyone share the cost (total, not just your portion) of an outpatient surgery?

I know there will be a HUGE variance. That's okay. I'm just trying to get an idea of the range. Rather, I'm trying to make sure that I'm off my naive, blessed with robust health coverage, rocker in thinking that it will typically far exceed $1200.

[MontrealMum]

I think it will depend on what the surgery is, and where it's done (hospital/clinic/office). But you mentioned that so here goes: I had outpatient knee surgery in your city back in 2001. It cost $16,500. No idea how much costs have gone up since then. My surgery was at a hospital (St. Mary's). My mom has had multiple outpatient surgeries (melanoma) at doctors' offices over the years that have cost much less. I have a good friend that is a general surgeon in your area who works some days in a low cost clinic. PM me if you want her info.

[ahisma]

That helps a lot, thanks! I can get actuarial data tomorrow, I'm just pulling my hair out tonight trying to sort out why the minimum value calculator is being goofy. You just helped me rule out the "I'm off my rocker" variable. Thanks!

[Mermanaid]

Dd had a non-essential implant in her arm last year at the local children's hospital. Total cost was $28,000.

[BunnyBee]

Really depends, as you know, on the procedure. I would guess the minor reasons happen more often than major ones. I know lots of people who've had moles or skin tags removed, but fewer who have had hernias or gallbladder surgery. The average may be lower because of that--many more $400 surgeries than $12,000 surgeries.
http://metrohealth.net/about-metro/quality-pricing/outpatient-surgery/outpatient-surgery-prices/

[♥ms.pacman♥]

i had sinus surgery last year (it was at a hospital, but was outpatient). i think the total was around $10,000. luckily i didn't have to pay any of it as our health insurance (which pay a pretty penny for) covered it all.

[crl]

I think one big variable will be whether general anesthesia is required. Having moles and such taken off with just a local will be much less than going under at an out patient surgery facility. Ds was put under general for dental work when he was three. We had it done at the out patient part of a hospital (UCSF). My memory is very shaky on this, but I want to say it was over 10k. And very little of the bill was the dentist. Most of it was the anesthesiologist and such.

Catherine

[jerseygirl]

As PP said, it all depends on the procedure and where it takes place. However, I'm assuming you know what you're having done and where and trying to figure out your out of pocket expenses vs how much it costs the provider to perform the procedure.

You'll need either a CPT code or a procedure code. Call the insurance company and give them that info. They should be able to tell you what they pay and what is patient responsibility. If your physician bills separately, add those costs in too.

In a hospital setting, the billing office/finance dept should be able to tell you approximately what it costs to perform that procedure. What they charge is not what it costs. For example, when you buy a $100 shoe, it did not cost the manufacturer $100 to make that shoe.

[crl]

As PP said, it all depends on the procedure and where it takes place. However, I'm assuming you know what you're having done and where and trying to figure out your out of pocket expenses vs how much it costs the provider to perform the procedure.

You'll need either a CPT code or a procedure code. Call the insurance company and give them that info. They should be able to tell you what they pay and what is patient responsibility. If your physician bills separately, add those costs in too.

In a hospital setting, the billing office/finance dept should be able to tell you approximately what it costs to perform that procedure. What they charge is not what it costs. For example, when you buy a $100 shoe, it did not cost the manufacturer $100 to make that shoe.

Good luck with that. The hospital refused to tell me how they would code it, insisting that it depended on how things went that day, insurance refused to tell me whether it would be covered until it was actually billed to them. So I got the hospital to give me an estimate so we could figure out whether we could cover the cost out of pocket if we had to. I have no idea why, but the number they gave me was ridiculously low compared to the final bill (there were no complications at all). Thank God insurance covered it.

Catherine

[Binkandabee]

A lot will depend on whether you need general anesthesia or not as a PP said. I had an outpatient procedure on my eyes in June under general anesthesia that took two hours of operating time. The bill was $22,000.00, the biggest portion of which was to the hospital ($13,000.00).

[ahisma]

Thanks, everyone!

To clarify, because my post was muddled: I'm not having any procedure, luckily. I'm trying to run a plan through the minimum value calculator that helps rank self insured plans as bronze, silver, gold or platinum. It's giving me results that I didn't expect so I was trying to rule out variables.

I had assumed that most surgeries cost more than $1200 when deciding whether to input the copay ($300) or the insured % (75%) for a particular plan. Since the breakpoint there is $1200 I was double checking my assumption.

No surgeries in my future, fingers crossed!

[jjordan]

I would expect that most would exceed $1200. My dd had her tonsils and adenoids out in February and I'm thinking that between the surgery center and the ENT, we probably got billed around $5000. At some point in there we met our deductible (high deductible plan, though earlier in the plan year we had a broken arm which was a significant portion of the deductible). Once that happened, insurance kicked in, so I don't know the total amount the ENT and surgery center ended up collecting from us + insurance.

[egoldber]

I think part of the issue is many minor procedures that are done (even in an office setting) can be billed as out patient surgery. Which is not what most people think of as "surgery". A surgery that requires inhaled or IV anesthesia is much different cost-wise than a surgery that only requires a local, injectable med. Also, any surgery that actually takes place in an operating room vs. in more of an office setting is also going to be much higher $$ simply because the cost to use that facility is higher.

Also, the hospital/facility bill is generally different from the doctor/surgeon bill. And the anesthesiologist, if necessary, will also generally bill separately.

DH had a kidney stone removed a year ago in a 2 hour start to finish outpatient procedure and the total bill was in the range of $6K all in for facility + urologist + nurse anesthetist.

[westwoodmom04]

I would expect that most would exceed $1200. My dd had her tonsils and adenoids out in February and I'm thinking that between the surgery center and the ENT, we probably got billed around $5000. At some point in there we met our deductible (high deductible plan, though earlier in the plan year we had a broken arm which was a significant portion of the deductible). Once that happened, insurance kicked in, so I don't know the total amount the ENT and surgery center ended up collecting from us + insurance.

Yes, this. A regular office visit to primary care doctor usually costs several hundred dollars, plus the cost of lab work.

[jerseygirl]

Good luck with that. The hospital refused to tell me how they would code it, insisting that it depended on how things went that day, insurance refused to tell me whether it would be covered until it was actually billed to them. So I got the hospital to give me an estimate so we could figure out whether we could cover the cost out of pocket if we had to. I have no idea why, but the number they gave me was ridiculously low compared to the final bill (there were no complications at all). Thank God insurance covered it.

Catherine

That's interesting that they wouldn't give you any information. I work in the financial side of healthcare so I guess I have a little bit of insider info. I would have asked to speak to a manager, then patient accounting director, etc. this information is available, just not sure why they're not sharing.

[niccig]

I think part of the issue is many minor procedures that are done (even in an office setting) can be billed as out patient surgery. Which is not what most people think of as "surgery". A surgery that requires inhaled or IV anesthesia is much different cost-wise than a surgery that only requires a local, injectable med. Also, any surgery that actually takes place in an operating room vs. in more of an office setting is also going to be much higher $$ simply because the cost to use that facility is higher.

This is true. I've had several "surgeries" that involved a camera scope in my mouth to check out my vocal folds. One ENT. at a teaching hospital billed $650 and I was outraged, as it's not "surgery". I now see a Dr. that is even better, but it's private practice. The bill was for $3000. Exact same procedure - camera scope in my mouth. My insurance refused it saying it was too high. The office settled for what insurance gave them, the customary amount insurance pays for that procedure, and thank goodness did not ask me to make up the difference. She's a fabulous Dr. but I can't afford her if I ever had to pay full amount.

[Pear]

DD had a 1 hour outpatient ga procedure. The hospital portion of the bill was $30k. The anesthesiologist billed a few thousand. The dentist was another $6k. Our out if pocket ended up being around 4k because the portion that was covered by dental maxed out on yearly limits quickly.

[pb&j]

The original bill from the hospital (not including surgeon/anes. fees) for my 3 hour surgery last year, for which I spent a total of 6 hours at the hospital, was $40,000.

With insurance rates and whatnot, the "real" charge was in the neighborhood of 4K, not including physicians' and anesthesiologists' fees which were billed separately. DH's outpatient surgery was similar in cost. DD's ear tubes (11 min surgery) were in the neighborhood of $3000.

While it was the hospital that billed, the surgeon was the one who submitted the code, and was able to tell me beforehand what the code would be.