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If you have a condition that requires surgery, you may be worried about the surgery cost. Factors that can affect surgery cost for you are:
- The type of surgery
- whether you are an inpatient or outpatient
- how anesthesia is used
- the specific health care facility
- what your health insurance covers
Surgery cost depending on the type of surgery
Surgery treats diseases and conditions with manual procedures according to Merriam-Webster. According to the American College of Surgeons, common surgeries include a breast biopsy to examine potentially cancerous breast tissue and tonsillectomy to remove one or both of the tonsils. Other surgeries, such as lung transplants, are more complicated. A lung transplant replaces a failing lung with a healthy lung from a deceased donor.
Surgery cost depending on inpatient versus outpatient
You’re an inpatient if you’re formally admitted to the hospital with a doctor’s order. According to the Mayo Clinic, a breast biopsy and tonsillectomy may both be done as outpatient procedures, meaning you go home the same day. A lung transplant involves several days in the hospital’s intensive care unit (ICU) and a one to three week hospital stay according to the Mayo Clinic. According to Medicare.gov, you could be an outpatient even if you spend the night in the hospital if the doctor hasn’t written an order to admit you to the hospital as an inpatient. If you have an extended hospital stay to recover after your surgery, your surgery cost could be higher than if you leave the same day.
Surgery cost depending on how anesthesia is used
Anesthesia is used to help prevent pain during surgery. Your surgery cost could depend on the type of anesthesia administered. According to the American Society of Anesthesiologists, there are three main categories of anesthesia.
- Local anesthesia is injected into the tissue to numb the specific location of your body where minor surgery will be performed. This could be for a procedure such as getting a mole removed. You are alert and awake with local anesthesia.
- Regional anesthesia includes epidural anesthesia and spinal anesthesia, which is injected into a cluster of nerves to numb the area of the body requiring surgery. Regional anesthesia may also be used for surgery on the arm, leg, or abdomen. You remain aware unless you are given a sedative.
- General anesthesia makes you unconscious with no awareness or sensations. You may breath anesthetic drugs through a breathing mask or be given them through a vein. The surgery cost of anesthesia can vary according to how long your surgery lasts. According to Sutter Health, there is one flat amount for general anesthesia for cases lasting up to and including 180 minutes. For surgeries lasting longer than 180 minutes, there is a higher charge.
Surgery cost depending on the health care facility
If you’re shopping for a gallon of milk, you may expect no more than a 25% or maybe 50% price difference from store to store. However, medical costs, such as surgery cost, can vary widely. According to the Washington Post, two hospitals in New York City 63 blocks apart charged a difference of 321 percent for similar care. According to CBS news, hospital costs can vary more than $200,000 for the same procedure. The same CBS report says that a joint replacement in Ada, Oklahoma could cost $5,300 and in Monterey Park, California cost $223,000.
Surgery cost depending on what your health insurance covers
While the cost of surgery without insurance could be staggering, surgery cost may be affordable with insurance. Your insurance may pay some or all of the costs of surgeon fees, anesthesiologist fees, and hospital care. You may able to ask your doctor, hospital, or facility how much you’ll have to pay for the surgery in advance. Even with health insurance, you may have a coinsurance or copayment for surgery. Coinsurance is a percentage of the cost you are responsible for and a copayment is a flat dollar amount. Your plan may also have a deductible, which is an amount you must pay before your plan begins to pay.