Cost of Surgery: Do You Know What You Are Paying For?

doctor checking cost of surgery

If you think that surgeries have a set price tag, then check again. The actual cost of surgery can vary widely depending on many factors including the facility, the type of surgery, and the surgeon’s fees. You may be surprised at your out-of-pocket costs even if you have insurance. You may not have needed surgery in your life, but maybe someone close to you has. In either case, knowing what you are paying for and what options are available is essential.

doctor checking cost of surgery

The costs of two surgeries -albeit the same type – may differ significantly. Have you ever thought this may be the norm? Our medical expense lawyers at Napoli Shkolnik PLLC can guide you through the medical billing system to understand what you are being charged for and whether or not those costs are fair.

The Cost of Surgery

Knee or hip replacement surgeries vary from less than $49,000 to more than $100,000, and spinal fusion surgeries come with a price tag between $95k and $221k. This is not exclusive to surgeries, though. An MRI for the lower back ranges from $1,500 to $10,000. 

These examples are not hearsay. They are readily available online after federal rules require hospitals and insurance companies to provide such information about surgeries and healthcare costs. This makes surgeries and other healthcare procedures an open market, like flights and hotels. Although it sounds like a well-thought-out system with experts verifying that the federal rules are intended to help decrease healthcare prices, this information is tucked away on pages that are hard to find. So, this information is not as readily available as it is supposed to be. 

Online Surgery Information: Is It All That Good?

Providing information online about cost of surgery may sound like an ambitious plan, creating a shopping-for-surgery need, no doubt. However, a patient in pain and in need of surgery will not always have the luxury to shop around for the best surgery prices; the only real choice they have is to find a hospital they can trust and a healthcare provider who can perform the surgery.

There are two significant downsides here. For one, high surgery prices drive up the cost of health insurance premiums. And secondly, there is the cost of deductibles and coinsurance; sometimes, a patient must pay close to a 20% coinsurance rate. Not to mention that many patients get blindsided by medical bills, and a significant percentage have debts due to medical or dental bills. 

Hospitals require patients to sign before performing any operation. Patients are often unaware of the final cost, paying thousands of dollars out of their own pocket. 

Is Online Surgery Information Bringing Down Costs?

Opinions vary on whether publishing online surgery information about costs can drive prices down. Some experts claim that it is too soon to tell if this will be a successful plan since costs could rise instead of fall, with hospitals pushing for increases to meet their competitors’ prices. 

Others believe an increase in price is as likely as a decrease, but most importantly, healthcare rates will become more stable. Before these federal rules were established, information about surgery costs and other healthcare procedures was kept somewhat secret, with providers and insurers negotiating in private. With more hospitals publishing information about costs, healthcare procedures have become an open market, and competitors can position themselves accordingly. 

A Direct Link between Healthcare Costs & Insurance Prices

Experts claim that healthcare costs drive insurance prices up, and they can verify this with examples. The Kaiser Family Foundation found out that the cost of individual coverage has risen by 43% and family coverage by 47% over the last decade.

Medicaid and Medicare programs that cover 79 and 64 million Americans respectively cover only part of the total cost of a surgery or other healthcare procedure. This accounts for 65% of patients having to pay some amount of money at the hospital. Similarly, 31% of patients have private insurance, and the remaining 4% lack insurance coverage.  

Medicaid pays 67 cents for every dollar spent on providing healthcare, and Medicare goes up to 90 cents per dollar. This is not the case for private insurance, though, with experts saying that if insurance companies paid the same rates as Medicare and Medicaid, hospitals would not be able to provide quality services to everybody, and many of them would struggle to stay open. 

Private insurance companies negotiate their prices with hospitals, and patients pay only a part of the deductibles or other charges. However, these prices vary significantly due to years of private negotiations between the parties. Things differ for uninsured Americans, who usually pay out of pocket. The charge is a cash price that can vary between insurers’ rates.  

Prices for surgery costs and other healthcare procedures get even more convoluted because hospitals publish gross charges, which are rarely charged but instead serve as the basis for negotiations with insurance companies. The result of these negotiations is then binding for 3 to 5 years. 

Keeping costs and prices in the dark is a disadvantage, and it is not an honest policy on behalf of insurance companies. Industry experts claim that it is because of what insurance companies pay that hospitals can continue providing their services as opposed to running solely on rates similar to Medicare and Medicaid. A prime example is Nassau University Medical Center which ran an outstanding $135,6 million deficit in 2021, providing care almost exclusively to Medicaid or uninsured patients. Rates paid by insurance companies cover the shortfall of Medicare and Medicaid. 

Contact Napoli Shkolnik PLLC for Information 

The outcome of the cost of surgery publishing plan is not yet known. However, information is still limited to consumers, and it is a fact that patients will primarily seek a provider that can cure them and seek a hospital they trust before going surgery shopping -unless, of course, they are exclusively paying out of pocket. 

Contact our team of expert lawyers at Napoli Shkolnik PLLC and get information on medical costs, whether you have already paid or are planning to pay. Learn how to get help with medical bills before running up substantial debt.