The Reasons Why Surgery Costs So Much
Surgery is expensive, and you may be wondering why it is so costly. While some procedures are less expensive than others, none are cheap and some cost hundreds of thousands of dollars. There are many costs associated with surgery that patients are aware of, but there are additional fees that are not so obvious.
Some surgeries that are commonly paid for by the patient, such as plastic surgery and weight loss surgery, may be offered at a flat all-inclusive rate, but that is the exception rather than the rule. Keep in mind that flat rate surgery may not include testing and a recovery that is not typical, such as a longer hospital stay.
Surgical fees that are billed by the hospital are often very different from what is actually paid by insurance, Medicare, and Medicaid. Insurers often negotiate significant discounts on services provided. If you are paying for surgery out of pocket, be sure to ask for the rate that insurance companies pay. You are also entitled to an itemized bill that lists each expense that contributes to your final bill.
The vast majority of surgeries require at least two physicians, and in some cases, more. There is always at least one surgeon performing the procedure, and an anesthesia provider. For more involved surgeries, several surgeons may work together to perform the surgery. Each physician involved in the procedure will usually submit a bill for their services.
Additional Staff in the Operating Room
In addition to the physicians participating in the surgery, there are at least two additional staff members 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 the person 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.
The Operating Room
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.
If your surgery requires an implant, such as an artificial hip or a mesh graft, there will be a fee for the implant. The price of implants varies widely, but the fact that they have to be sterile, made to perform for a lifetime and require extensive research and testing usually makes them quite costly.
The medications used during surgery are an additional expense during surgery. The medications given range from IV fluids and anesthesia medications to any special drugs that are necessary during the procedure, such as an antibiotic.
The recovery room often referred to as the Post Anesthesia Care Unit or PACU, is where patients are taken after surgery to be monitored while the anesthesia wears off completely. There may be an individual charge for the time spent in recovery, along with any medications given.
Pre-Surgery Testing and Care
Your road to surgery will begin with a consultation with your surgeon, which will result in a fee. Any additional visits with your surgeon, both before and after surgery, may also result in fees.
Your surgeon may order testing to make sure you are healthy enough to tolerate the stresses of surgery. These tests may 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 deems necessary. These tests can range from hundreds of dollars to thousands of dollars each and can add substantially to the cost of surgery.
The day of your surgery may also result in additional fees for pre-operative procedures (such as inserting an IV) and standard blood work.
If the recovery from surgery is done on an inpatient basis, there will be a substantial fee for the hospital room and the nursing care that accompanies it. At this time, additional tests, medications or care may be required, all of which will increase the cost of the procedure.
If your recovery takes place in the ICU, as is common with open heart surgery, transplants, major lung surgery, and trauma, you can expect the cost to rise significantly. In some cities, 24 hours in an ICU costs a minimum of $5,000 not including standard ICU care such as x-rays, blood tests, and medications.
Consultation by Physicians
When the surgeons and any other physicians who are participating in your care check in on you each day during your recovery, an additional fee is often generated. This is how the doctors are paid for their time and expertise when you are being cared for in the hospital.
Physical and Occupational Therapy
After some surgeries, such as orthopedic surgery, physical therapy is often part of the recovery process. Physical and occupational therapists will assist you in getting back on your feet as quickly as possible and returning to your normal activity.
Social workers are an important part of coping with a hospitalization for many people. Social workers help people determine ways to pay for a surgery (for example, social workers would help you apply for government benefits) they also help plan your discharge from the hospital.
If you need a special bed at home, or if you need to spend some time at a rehabilitation facility before returning home, social workers help make those arrangements. There is usually no individual fee for social work.
If you require crutches, a cane or a similar appliance before your discharge, you will probably see it on your bill. The same is true for products like supportive stockings to prevent blood clots, binders to support an incision, or a sling to support an arm in a cast.
- Hospital Bill Auditing. Summary Hospital Bill or Itemized.