Depending on the surgery, the out-of-pocket cost can range between $4,000 to $170,000. The most expensive surgery is heart valve replacement surgery. LASIK eye surgery and other elective procedures may cost less. Factors like where you get the surgery done, the type of surgery you're getting, and pre or post-surgery care will impact the cost.
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The Cost of Surgery Without Insurance
Paying for surgery out of pocket can vary greatly, costing you between $4,000 and $170,000, depending on what surgery you get. LASIK eye surgery may cost you about $4,000 because the surgery is less intensive, takes less time to perform, and can be an outpatient procedure, which is less expensive when compared to inpatient procedures.
However, more extensive surgeries such as a heart valve replacement or heart bypass are more expensive for the following reasons:
- Pre and post-operative hospital stay. Before and after receiving surgery, you will likely have to stay in the hospital. This is to make sure you are prepared for the surgery and are recovering well after. The average hospital stay is 6-7 days for bypass surgery.
- Pre-surgical treatment. Pre-surgical treatment is done to increase the success of the surgery; this may include catheterization and other treatments necessary to ensure that bypass surgery is successful.
- Anti-rejection medication. Anti-rejection medicine is necessary to prevent your body from rejecting any new organs, arteries, or valves after surgery. It may be prescribed for transplant surgeries as well.
The Average Cost for Surgery
Below we outline the out-of-pocket cost for surgeries. The most expensive surgeries are heart valve replacements, heart bypass, and spinal fusion surgeries.
|Heart valve replacement||$170,000|
|Replace or revise brain shunt||$49,355|
|Removal of pacemaker or defibrillator||$52,005|
|Partial removal of the colon||$52,353|
Factors That Influence the Cost of Surgery
As you can see from the data above, the cost of surgery ranges significantly. Some factors that may influence the price include the following:
Where your surgery is done (facility and location)
Whether you get your surgery done at an inpatient or outpatient facility will affect the cost you pay. Additionally, your location will also play a role in the price.
Inpatient vs. Outpatient Care
Inpatient care, such as hospitals, is primarily used in cases of complex surgeries and some routine ones, serious illnesses, or medical issues that require substantial monitoring. Outpatient care, such as a doctor's office, is used for X-rays, MRIs, CT scans, and other types of imaging, lab tests, mammograms, and minor procedures.
A study shows that outpatient procedures are significantly less expensive when compared to inpatient procedures. Outpatient procedures averaged $3,800 per patient, while the inpatient facility charge was 350% more expensive at $13,200 per patient (this was about $9,500 in savings). There was no difference between the inpatient and outpatient groups in terms of complications or readmissions.
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The cost will also be dependent on your general location, such as state and city. Across different metro areas, there can be up to a 25-fold variation in prices of the same surgery or procedure:
- The median price for C-sections in San Francisco-Oakland-Hayward, CA ($20,721) was nearly 4.5 times that in Knoxville, TN ($4,556).
- A standard blood test in Beaumont, TX ($443) costs nearly 25 times more than the same test in Toledo, OH ($18).
- Established patient office visits had median prices three times larger in Anchorage, AK ($165) than in Miami-Fort Lauderdale-West Palm Beach, FL ($60).
Pre or Post Surgery Care
Before and after you receive surgery, you will likely have to stay in the hospital. Before surgery, your surgeon may order tests to make sure you are healthy enough to tolerate the stresses of surgery. The tests can range from blood tests and chest x-rays to stress tests, imaging tests (CT, MRI, Ultrasound, PET scans), and any additional tests that the surgeon finds necessary. These tests can range from hundreds of dollars to thousands of dollars each and can add substantially to the overall cost of surgery. Any additional visits with your surgeon, both before and after surgery, may result in additional charges.
The day of your surgery may also result in additional fees for pre-operative procedures (such as inserting an IV) and standard blood work. You may also need to spend a certain number of nights in the hospital before being discharged. Any medications prescribed to you during this time will also result in additional charges.
The cost of anesthesia is based on the "units" required for the surgery or procedure, and each unit will last for about 15 minutes. Units can vary anywhere from $50 to $70. The more complex a surgery is, the more units it will require.
For instance, a bypass surgery could take up to 20 units, while getting your wisdom teeth removed can take less than six. General anesthesia, however, will be calculated on a base unit, as specified above, and the value will be determined by the surgical procedure. On your medical bill, you may see your anesthesia billed by the minute and then converted into units on your medical bill.
Standard procedures, such as colonoscopies or upper endoscopies, will generally produce an anesthesia charge of $150 to $300. Procedures for minor joint surgeries and spinal injections may cost $300 to $400, while more complex surgeries, such as joint replacements, may cost $3,500 or more.
Additional Staff & Operating Room
As shown above, the type of surgery you get essentially impacts the price you will have to pay. This is due to the additional staff needed to perform that surgery and the operating room cost.
In addition to the physicians participating in the surgery, at least two additional staff members were in the operating room during the procedure. A circulating nurse is present, charting everything that happens during the procedure and doing the things that the "scrubbed in" staff cannot. A surgical technologist, commonly known as a Surg Tech, or ST, is responsible for handing the surgeon the sterile instruments used during the procedure. The fee for this staff may be included in the operating room fee.
An operating room is billed in 15-minute increments in most facilities. The fees include the sterilization and use of instruments, the anesthesia machinery, the cleaning of the room after the procedure, and other items that are used during the surgery.
Paying for Surgery Without Insurance
While it can be daunting to pay for the surgery out of pocket, there are ways to make the cost more affordable.
Some surgeons and hospitals offer payment plans for their services. Payment plans are commonly offered when your surgery is routinely paid for by the patient instead of an insurance company. In some cases, payment plans are a formal agreement that you will make monthly payments to pay for the expenses of your surgery. In other cases, the payment plan is a loan, but the hospital or surgeon is involved financially. Some hospitals may offer a payment plan for their services, but the plan is a monthly pre-payment plan finished by the time surgery occurs.
Monthly payments, even if they are not large, are more attractive to the billing department than no payments, and it may keep the debt from appearing on your credit report as a negative account.
Use Your Savings
If the surgery is necessary, you may want to consider taking money from your savings to pay for it. While spending your life savings on something like surgery is not ideal, it may be money well spent if the surgery improves your quality of life. Depending on your credit and income, you may want to borrow the funds from an outside source and keep your savings easily accessible.
While a loan will result in interest being charged, it may be worth the extra money paid in interest to maintain the security of a nest egg or emergency fund, especially if you may need the funds during your rehabilitation if you cannot work.
Medical fundraising or crowdfunding is a great way to raise money for medical surgeries or procedures. Crowdfunding can ease financial stress and allow you to focus on healing.
- Medical crowdfunding helps spread your story among your family, friends, friends, and even strangers who want to support you during a difficult time.
- Crowdfunding can get you the funds you need fast when you're facing mounting medical bills. You can begin withdrawing funds as soon as you start receiving donations.
- Crowdfunding can help spread awareness about certain medical conditions and the healthcare system.
Reason with Collections
The people at the hospital's collections can help you set up a payment plan and have the power to reduce the total amount of money you owe.
If you are paying for surgery out of pocket, you may want to ask to pay the same rate that insurance companies have negotiated for the same procedure.
Avoiding High Costs When Getting Surgery
Keep an eye out for ways to avoid high costs when getting surgery and paying out of pocket:
Ask for an itemized bill
"We estimate about half of all medical bills have a mistake in them, and we've never seen a mistake work out in a patient's favor," says Caitlin Donovan, health care policy expert at the National Patient Advocacy Foundation.
There are common mistakes you should look out for when receiving your itemized bill. Below is a list of common errors on medical bills:
- Duplicate costs (i.e., you get charged twice for a procedure or medicine).
- You've been charged for a procedure, service, or medication you didn't receive. Use the Medicare code lookup to check that the codes on your explanation of benefits match the type of care you received. However, it can be a bit confusing. Sometimes a Google search can also help you find what certain codes mean.
- A procedure or medication price is inaccurate.
- Your insurance was supposed to cover something that it didn't.
- Your condition was misrepresented on the bill, also known as upcoding.
- You're missing your Explanation of Benefits (EOB).
See if your surgery can be done at an outpatient facility
More patients are turning to outpatient facilities—such as physicians offices and ambulatory surgery centers— due to the affordable alternative when compared to outpatient.
Kaiser Health News found that over two-thirds of operations performed in the United States occur in ambulatory surgery centers. Leaving out the high cost of running a hospital to factor into your medical bill, outpatient facilities can provide the same healthcare services at a much lower cost.
Travel to a different state for your procedure
Depending on where you live, the cost of your medical procedure might be astronomically high. This often happens in rural areas where there is a shortage of hospitals and providers, which causes the cost of healthcare to rise.
While not everyone has the means to travel for surgery or a procedure, it can be a great option that could lead to saving money. How much you save will depend on the cost of your medical procedure and the cost of travel but, for many patients, the cost difference is well worth it.
Shop around for a fair price
Before settling on one place to get your procedure done, you may want to shop around to find the best price that you're comfortable paying.
Websites like New Choice Health have developed systems that help consumers find and compare pricing information for different medical procedures without jumping through hoops. You can compare the cost of your medical procedure across various facilities, so you can get an accurate picture of what you can expect to pay — and choose where you get care accordingly.
Ask for generic prescriptions
Prescriptions can be expensive, and many doctors prescribe the drug's brand name without thinking much about it. If you're insured, you may only have a small prescription co-pay. If you don't have health insurance and need medication, you could be faced with the choice between paying hundreds to thousands of dollars per month or going without your prescription.
One way to save money on prescriptions is to ask your doctor to prescribe you the generic version of the same medicine. Generic drugs are a safe and effective alternative; they're FDA-approved and contain the same active ingredients as their brand-name counterparts. They can also cost up to 80% less compared to brand-name versions.
Getting surgery without insurance can be expensive, and depending on your surgery, you can expect to pay thousands of dollars out of pocket. It'sthey're important to pay attention to additional factors that will influence the cost and look into ways to pay for your surgery prior to getting it.