How Much Will Surgery Cost? Understanding Your Financial Responsibility

Oftentimes, I receive emails from clients that they’ve had surgery, a procedure, or a diagnostic test, and then months later, a bill comes in the mail.

Naturally, the first thing they ask me is, “Why did I get this bill?”

Although you have insurance, it isn’t enough to ensure that you will not receive a bill in the mail. I recently underwent a total hip replacement surgery. The type of surgery was a common posterial procedure, which required a three-day hospital stay followed by 10 in-home physical therapy sessions over a two week period. After the in-home sessions, I had a post-operative visit with my doctor where he then gave me a prescription for outpatient physical therapy.

Prior to my surgery, I made calls to my carrier to know what my financial responsibility would be before I went to the hospital. I did not want to have any surprises when I returned home. While recovering, I wanted to focus on getting back on my feet without worrying about hospital bills that would make my pain more painful.

How To Tell What You May Need To Pay

With insurance comes the responsibility to understand how it works and what your share of the cost might be. The ID card we all receive can be a big help.

First, it should always be presented at the time of surgery or any doctor or diagnostic visit to ensure the claims go to the correct carrier. There is a customer service number on the card so you can call customer service to ask any questions about your current plan, cost, and coverages.

Many times, I find clients get their information from the doctor’s office. Although doctors are knowledgeable, they cannot give you an accurate account of charges and your financial responsibility.

I wanted to get my information directly from the insurance carrier. Hence, I called and I called and I called again to check and double check the information. The first question I asked was if the surgery would be covered and if there would be any out of pocket expenses.

Questions To Ask Before Your Surgery

These are some of the particulars I asked to see what my costs would be:

1. Is the hospital in-network or out-of-network?
2. Is the doctor in-network or out-of-network?
3. Is the anesthesiologist in-network or out-of-network? (I didn’t know who mine was until that day, but I was assured I would not pay out-of-network since the doctor and hospital were both in-network. You must check with your carrier, as all plans work differently.)
4. How many hospital stays are allowed for this surgery?
5. Is the in-home physical therapy in-network, and how many visits are allowed?
6. What facilities for outpatient physical therapy are in-network, how many sessions are allowed, and what are my costs?
7. Do I need pre-certification for the surgery or physical therapy? (Check closer to the surgery date to make sure this was done. The doctor’s office does this for you; however, it is up to you to make sure it was completed and, in some cases, processed through the correct carrier.)

Even after many calls to my insurance company, a few days after returning home, I still received a letter from the hospital saying my insurance would only cover a three-day stay, so I would have to pay for the other two.

What To Do If You Get Charged

Don’t panic if you get a bill. Call the insurance company. I was there only three days. I called my insurance carrier, explained my situation, and they told me I had nothing to worry about. It was an error.

A part of having insurance is the responsibility to do your research and ask questions before a surgery/procedure or diagnostic testing. The other part is to look at your Explanation of Benefits as they arrive. Many people never look at the EOBs, but they will give you the billing breakdown and tell you if there is any patient responsibility.

It has been two months since my surgery and luckily, all is well and there were no financial surprises!