Every year, roughly 330,000 hips are replaced in the U.S. and most of those people will get completely different medical bills. Why? Because the cost of medical care depends on where you’re receiving your care, the provider you choose, the insurance you have and the nuances to your particular surgery. For instance, the longer your surgery is, the more you have to pay the anesthesiologist. Even providers within the same network can charge vastly different prices for the exact same services.
Given this information, how are you supposed to know what you should pay? The answer is Healthcare Bluebook which calculates the “Fair Price” for medical services and surgeries based on the actual amounts health plans pay in claims.
The Fair Price for Hip Replacement Surgery
According to Healthcare Bluebook, hip replacement surgery can cost you anywhere between $23,203 and over $74,000. Anecdotally, I know a woman whose hip replacement surgery bill came to $102,000, so the range is wide.
Healthcare Bluebook estimates the fair price for hip replacement surgery to be $25,779. Here’s how that cost breaks down:
- Implant Cost: $8,000 (Check with your provider to see which implant they plan to use as that can affect cost.)
- 3 Days Admission: $5,400 (Estimated at $1,800/day.)
- Other Hospital Charges: $8,515 (These can vary.)
- Total: $21,915
- $2,679 (For procedure and standard post-op care.)
- $1,185 (Price for an average surgery time of 2.5 hours. Actual price depends on surgery time.)
Grand Total: $25,779
Keep in mind these costs only reflect a fair estimate for the cost of the actual surgery and don’t include physical therapy or any medication you might need before or after surgery.
How Much Will You Actually Have to Pay?
Your out-of-pocket cost for hip replacement surgery will depend on your insurance. Remember that woman whose bill for surgery was $102,000? She was only responsible for $520 of that because she’d already met her deductible and had otherwise great health insurance.
If you don’t have health insurance, you’ll be responsible for the entire cost. If you do have health insurance, it will depend on your deductible, co-insurance and max out-of-pocket cost.
According to Healthcare.gov, typical healthcare coverage breaks down as follows:
- Deductible: $1,300
- Co-insurance: 20%
- Max Out-of-Pocket Cost: $4,400
If this was your plan, and your hip replacement was the first medical procedure you had in that calendar year, you would be responsible for $4,400 of that bill. If you’d already reached your deductible, then you would be responsible for 20% of the cost up to $3,100 ($4,400 max out-of-pocket minus the $1,300 deductible you’ve already paid).
To figure out what your hip replacement surgery is likely to cost you, first ask for a price estimate from your provider. Make sure to ask about the type of implant they’re planning to use, the estimated length of the surgery and how long they think you’ll need to stay in the hospital. Then shop around to make sure you’re getting the best price for quality care.
Once you’ve chosen your provider and have their estimate, get the following information from your insurance company:
- Amount remaining on your deductible.
- Co-insurance you’re responsible for.
- Max out-of-pocket cost.
Once you have that information, you can calculate how much the hip replacement surgery is likely to cost you personally. It sounds like a lot of work up front but a little research and shopping around can be the difference between paying thousands (or tens of thousands) of dollars for your surgery, and paying $500.
Medical Expense Series
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