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HOW MUCH OF MY SURGERY COST WILL MY INSURANCE COVER?

A surgical procedure comes with many worries and questions: how much will the surgery cost? Is it painful? How long will it take to recover? Will my healthcare insurance cover it? Etc. We all agree that many people are concerned about costs when it comes to surgical procedures since they can be expensive. This guide explores all you need to understand about your healthcare insurance and the questions to ask your provider regarding surgical procedures.

Coverage differs depending on the insurer.

Every health plan is unique. You have two tasks to complete to best prepare yourself for the economic effects of your surgery: consult with your healthcare professional and review your health insurance plan.

Ask your surgeon for an estimate of the cost of surgery and the necessary materials, care, and prior planning. Keep in mind that hospitals and other healthcare facilities may struggle to give precise estimations since they are unsure of what to expect once the operation has started. However, you will learn more the more questions you ask.

You also want to understand how your cost-sharing with your insurer will work. Your deductible amount is essential to know because it affects the majority of surgical procedures. Additionally, once your deductible is cleared, you might have to pay coinsurance (a portion of the bill) until you reach your plan’s out-of-pocket maximum.

Consider other costs of your surgery.

Surgery has a financial impact beyond a single treatment’s price. Other expenses could include:

  • Pre-operative examinations that assist your doctor in getting ready for surgery or ensuring your readiness for it, such as blood testing, X-rays, MRIs, etc.
  • Using the operating room or other surgical facilities, which has a cost per hour or per procedure
  • Co-surgeons or surgical assistants who assist in the operating room, such as nurses
  • You may require blood, plasma, or other biological support to maintain your condition.
  • Anesthesia
  • Medical supplies like crutches or braces that might be necessary after your surgery.
  • The recovery room where you receive care after surgery
  • Your stay in the hospital if you need inpatient care5
  • Charges for skilled nursing facilities if you need intensive rehabilitation after leaving the hospital but before going home
  • You may require part-time nursing care or treatment while recovering at home.

The no surprises act protects you.

You must (or have to, depending on your health plan) choose a doctor and hospital that are in the insurance plan’s provider network. Additionally, it’s a good idea to confirm that everyone involved in your procedure is a part of the provider network for your insurance plan.

But the No Surprises Act, which went into force in 2022, makes this less of an issue than it formerly was. If a patient receives care at a hospital, hospital outpatient clinic, or ambulatory surgery center—which includes the majority of locations where procedures are carried out—the No Surprises Act safeguards against surprise balance billing.

The bottom line

The amount your insurance covers for your surgery costs will depend on your health plan. The deductible and coinsurance you owe and the surgery’s actual cost also come into play.

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