Paying for hip replacement surgery
Description
Hip replacement and care can be costly. Most health plans cover much of these costs. But finding out the cost weeks before surgery can save you hassle and money afterwards.
What will hip replacement surgery cost?
The cost of hip replacement may vary in different parts of the United States. It can also vary between different hospitals and surgeons.
The average cost for hip replacement surgery without any insurance in the United States is about $30,000. However, depending upon where you live, it could cost as little as $16,000 or as much as $70,000. The cost can vary even within each area of the country.
In general, this cost includes:
- Visits with your orthopedic surgeon before surgery, including a physical exam and medical history.
- Surgeon fees for the surgery itself.
- Cost of care while you're in the hospital after surgery.
Serious complications during or after surgery, may add an extra cost -- up to many times the cost of surgery.
Other care you receive can also add to the cost. This may include:
- Fees from the anesthesiologist (the doctor who will give you anesthesia, the medicine that will make you unable to feel pain during surgery).
- Blood tests and x-rays that are done before and after your surgery.
- Medicines or supplies you need during recovery.
Talk to your insurance company
Most health insurance plans and Medicare will pay for the costs of your hip replacement surgery. Your surgeon's office and the hospital will often call your insurance company themselves.
Even if your insurance covers your surgery, you may still need to pay part of your bill. Most insurance plans, including Medicare, have what are called copays, coinsurance, deductibles, or out-of-pocket expenses. These are the fees you must pay.
Often, your surgeon and the hospital can tell you how much of the costs are covered and what you will need to pay yourself.
Items your insurance may often NOT pay for include:
- Changes to your home, such as handrails, special pillows or pads, or equipment to help you reach or pick up items in your home
- Special canes or walkers
How to find out what your insurance or Medicare will pay for
Sometimes, your insurance will not pay for care unless they approved it before the care occurred. This is called preauthorization.
Find out exactly what your insurance company will cover ahead of time. Get answers to these questions:
- Is the type of surgery you are having covered? Sometimes, newer methods for doing hip replacement may not be covered.
- Is there any exclusion to hip replacement surgery in your plan? In other words, are there any hip replacement surgeries your insurance does NOT cover?
- Does your surgeon and hospital have a contract with your health insurance plan? If they don't, your insurance may not pay for you to use this surgeon and hospital. Or they may not pay for as much of the bill.
- Are physical therapy, home health nurses or aides, and other services after you go home covered? You may need this after you go home.
- If you are going to a skilled nursing facility to recover after your hospital stay, ask if your insurance covers the stay and the facility you have chosen and also for how long.
If your insurance company denies or refuses to cover your surgery, you can appeal this decision. Find out why your coverage was ended and submit an appeal.
Remember, you should do ALL of this long before you go to the hospital for surgery.
Reviewed By: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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