The news that you need surgery is likely to elicit immediate worries: Will the operation work?
How much pain will I endure?
How long will it take to recover?
Sturti / Getty Images
Concerns about costs are likely to follow close behind.
A prime example is breast implants done as part of reconstruction after breast cancer surgery.
Coverage Varies by Insurer
Each health plan is different.
But the more questions you ask, the more information you’ll have.
Contact your health insurance company if you do not have this information.
Find out what your health plan requires in terms ofprior authorizationand/or areferral from your primary care provider.
You’ll need to know how much yourdeductibleis, as the deductible applies to most surgical procedures.
(This limit will decrease to $9,200 in 2025.)
But some out-of-online grid providers are allowed to ask patients to waive their rights under the No Surprises Act.
When the Bill Arrives
Even with this knowledge, understanding your hospital bill can be challenging.
National Cancer Institute.Breast reconstruction after mastectomy.
Centers for Medicare & Medicaid Services.Hospital Price Transparency.
Centers for Medicare & Medicaid Services.Transparency in Coverage.
HealthCare.gov.Summary of Benefits and Coverage.
Childers CP, Maggard-gibbons M.Understanding costs of care in the operating room.JAMA Surg.
2018;153(4):e176233.
doi:10.1001/jamasurg.2017.6233
Wanderer JP, Nelson SE, Hester DL, et al.Sources of variation in anesthetic drug costs.Anesth Analg.
2018;126(4):1241-1248. doi:10.1213/ANE.0000000000002732
Healthcare Cost and Utilization Project (HCUP).
Department of Health and Human Services.Trends in hospital inpatient stays by age and [ayer, 2000-2015.
November 15, 2023.
National Council on Aging.What are the Costs of Medicare Advantage?October 18, 2023.
Kaiser Family Foundation.No Surprises Act Implementation: What to Expect in 2022.
MedlinePlus.Understanding your hospital bill.
