You’re buying a car. You compare models and prices; even take one for a test drive. You’re considering a new high-def screen TV. You ask your friends if they like theirs. You mull the amazing choices at the local electronics store. You read up on all the reviews and buy the one that fits your family room.
Now, your doctor says you need surgery. What questions should you be asking to make sure you get the best value and the features you want? And can surgery really be treated like a major purchase?
“Yes, patients have control and they need to exercise it,” says Douglas Khoury, M.D., F.A.C.S., a Davenport general surgeon and partner in the Mississippi Valley Health Network. “You need to consider that you are actually purchasing a service, which is more important than any item you could possibly buy. Asking the right questions helps you control surgery costs, limits scarring, and allows you to return to your normal activity level as soon as possible,” explains Dr. Khoury.
Patients can control costs
As healthcare costs rise, patients are facing higher out-of-pocket expenses for healthcare in the form of increased co-payments and deductibles. However many people are also unaware that their choice of where a surgery or procedure is performed can make a difference in the cost for a patient.
In many cases, a patient will pay less to have a procedure performed in an ambulatory surgery center (ASC) compared to a hospital. Studies have shown that procedures performed at an ASC cost significantly less than the same procedure performed at a hospital setting, according to a November 2006 US GAO Congressional Committee’s report on Medicare.
Insurers are also taking note. In April of 2008, Wellmark Blue Cross and Blue Shield approved Mississippi Valley Surgery Center to perform total joint replacements in the outpatient setting. “Insurers are always considering safe and cost effective alternatives,” says Dr. John Hoffman, a fellowship-trained surgeon at Orthopaedic Specialists, PC. “To pass muster with major insurance carriers validates our efforts to provide patients with not only a quality, but cost effective option for having their joint replaced.”
Ask what your surgeon’s fee is and what it covers. Surgical fees often also include visits after the operation. You will also get a bill from the facility for your care and from other providers related to your surgery such as anesthesiologists, radiologists, laboratories, etc. Before your operation, call your insurance company to verify coverage.
They will also tell you how much of the costs your insurance will pay and what share you will have to pay.