I have represented hundreds of clients who underwent surgery as a result of injuries. Most of these clients had no idea how expensive their surgery would be, and were often shocked when all of the bills arrived. I use the word “bills” (plural) because numerous providers in the operating suite (not just the surgeon) separately bill for their services, including the anesthesiologist, hospital, assistant surgeon, and sometimes even the surgical nurses. Thus, it is now common for routine surgeries requiring just one night in the hospital to cost over $100,000. One of my clients went into the hospital on a Friday after a motorcycle accident, underwent spinal fusion, and was discharged two days later on Sunday with a bill exceeding $300,000.
What makes these billing practices so alarming is not only the sticker shock of the bills themselves, but the lack of transparency in the process leading up to surgery. For example, most surgeons don’t discuss the cost of the procedure with patients before surgery. Many surgeons also don’t mention that an assistant surgeon may be assisting with the procedure (a surgical resident, for example) and thus that resident may charge for her services as well. In one case, a patient received $117,000 bill from an assistant surgeon whom he never met and was outside of a patient’s health insurance network. Click here to read the New York Times’ article regarding this case.
More often than not, patients have no idea how much they will owe after undergoing surgery. They are understandably most concerned with getting through the procedure safely, and assuming that their health insurance will cover most of the bills. However, because medical providers are under significant financial pressure due to lower insurance reimbursement rates, billing practices have become mind-bogglingly difficult to decipher, and are almost always left for discussion after the surgery is complete — too late to do anything about it.
That is why you should arm yourself with knowledge of the bills you may receive well before you go under the knife. To do so, ask the following questions of your surgeon and/or his staff during your pre-op consultation (preferably weeks before surgery):
- Are you a preferred provider for my health insurance plan?
- How much will you charge me for this surgery and follow up care?
- Will there be others in the operating room with you? If so, who will be there, and how much will they charge me?
- Will the other people in the operating be preferred providers on my health insurance plan?
- How much will I have to pay, in total, for this procedure and follow up care?
Keep in mind that your surgeon may not even know how much he bills for your procedure, let alone how much others in the operating suite will charge. If that is the case, ask the surgeon who can answer all of these questions. You will likely have to make numerous phone calls to different providers and billing departments. Document all of your conversations to keep an accurate record of what was discussed. While doing this kind of homework before a surgery may seem like an added layer of stress, it could prevent an even bigger headache down the road in the form of financial disaster.