The average cost of shoulder surgery ranges from $6,000 to $22,000. Occasionally, shoulder surgery can cost as much as $50,000, but that’s unusual.
The amount patients with health insurance must pay depends on their insurance deductible and copay. insurance plans vary widely and my staff will work with you and your insurance company to determine what your out-of-pocket cost will be.
Reading: How much does shoulder surgery cost without insurance
There are several different types of shoulder surgeries and the cost will vary depending on the exact procedure your condition requires. the cost will also vary depending on the types of implants used and where the procedure is performed.
copayments and insurance deductibles
Most insurance plans cover shoulder surgery, but a patient’s out-of-pocket costs vary widely. A good place to start your research is to familiarize yourself with your insurance company’s schedule of benefits, which is usually available online.
Most insurance policies require the patient to pay a specific amount before benefits begin to pay anything. this is known as your “deductible.” After you meet your deductible, most policies will pay a percentage of your bill and you’ll be responsible for the remaining balance.
It would be a very good idea to call your company for clarification and to make sure you fully understand the coverage.
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Most offices and surgical facilities will determine your out-of-pocket costs so there are no surprises. As you plan your surgery, keep in mind that patients must pay their shoulder surgery deductible up front.
are there additional costs?
Anesthesia is required for shoulder surgery and is often billed separately. On average, the price of anesthesia starts around $600 for a surgery that lasts 30 minutes to an hour.
Invasive shoulder procedures, such as a total shoulder replacement or reverse shoulder replacement, may require that your procedure be performed in a hospital.
Costs for hospital procedures are often more complicated and require more expensive implants. In addition, referral charges for hospital procedures are much higher for the same procedure performed at an orthopedic surgery center.
Also, there are some newer techniques that are considered experimental and are not covered by insurance. an example of this is an “upper capsule reconstruction” for an irreparable rotator cuff tear, or the addition of orthobiologics (bone marrow concentrate, umbilical tissue, prp) to aid healing. Choosing to undergo these procedures is an individual decision and is based on your recognition that the cost is yours and will not be subject to insurance.
Some surgeries will require medication for a few weeks after surgery. this cost is usually minimal and is often covered by insurance.
Physical therapy after surgery is very important to your recovery. the time you will spend in physical therapy and the cost will depend on the type of surgery you need. Most health insurance companies will help you with the cost and ask you to contribute a copay per session. the cost of a copay varies widely among insurance companies.
estimates
Ultimately, the responsibility for the cost of the surgery rests with the patient. being proactive will allow you to make the best decisions when budgeting for your surgery.
Our office will give you a pre-treatment estimate for all of your surgical costs. our staff is dedicated to making sure you are fully informed. we want to take the mystery out of this complex process and make it understandable.
some costs we will review with you:
- hospital / surgery center
- implants or prosthetics
- anesthetics
- tests (radiology, pathology)
- postoperative care
This estimate allows you to check with your health insurance company to make sure you fully understand what your total out-of-pocket cost will be.
Don’t be afraid to ask questions about something you don’t understand.
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