How Much Does Outpatient Surgery Cost?

[somarco]

Planning an outpatient procedure?
You may have options for where you have your outpatient procedure.

Compare national average prices for procedures done in both ambulatory surgical centers and hospital outpatient departments.
You’ll see how much the patient pays with Original Medicare and no supplement (Medigap) policy.


[EXTERNAL LINK] - Procedure Price Lookup for Outpatient Services | Medicare.gov

 

[kgmom219]

I love this thing. Doesn't really matter for Supp and G, but its super helpful for Under 65's,

Remember, provider contracts are typically X% of Medicare for reimbursement on group and ACA.

 

[somarco]

Doesn't really matter for Supp and G,

I suppose it could be used to show folks who don't want to pay for a supp and don't want MA how much they will be expected to pay with Medicare only.

Of course those who are under 65 and don't have REAL insurance won't find this helpful. They will be billed Chargemaster rates.

Same applies to those who buy the junk indemnity plans.

 

[kgmom219]

I suppose it could be used to show folks who don't want to pay for a supp and don't want MA how much they will be expected to pay with Medicare only.

Of course those who are under 65 and don't have REAL insurance won't find this helpful. They will be billed Chargemaster rates.

Same applies to those who buy the junk indemnity plans.

A few years ago I called around and was fascinated in the cost differences between hospitals (same company) on labor and delivery rates. It was a 20 mile/$4K difference on the cost. When you've got a $6K deductible, those numbers matter.

 

[CaptainPlanet]

Is there a tool like this for Inpatient services i.e. doctors billing to part B

 

[somarco]

Is there a tool like this for Inpatient services i.e. doctors billing to part B

Not that I am aware of . . . and I doubt it exists since there are so many variables to make it worthwhile. For inpatient surgery it can range from organ transplant to ligament repair . . . and then you have anesthesia on top of that.

My wife had OP surgery for upper eyelid reduction (medically necessary, not cosmetic). Anesthetist charged $2800 . . . Medicare paid $185 . . . doc accepted assignment . . . PAID IN FULL.

Surgeon billed $4500 . . . Medicare paid $667 . . . PAID IN FULL

OP surgical suite was another issue. Hospital (incorrectly) submitted claim to Medicare coded as COSMETIC . . . Medicare denied all of the $19,610 charge. I appealed and pointed out the miscoding . . . resubmitted to Medicare who paid $1952 (after discount) . . . Medigap G paid $498 balance leaving us owing $0.

 

[CaptainPlanet]

Not that I am aware of . . . and I doubt it exists since there are so many variables to make it worthwhile. For inpatient surgery it can range from organ transplant to ligament repair . . . and then you have anesthesia on top of that.

My wife had OP surgery for upper eyelid reduction (medically necessary, not cosmetic). Anesthetist charged $2800 . . . Medicare paid $185 . . . doc accepted assignment . . . PAID IN FULL.

Surgeon billed $4500 . . . Medicare paid $667 . . . PAID IN FULL

OP surgical suite was another issue. Hospital (incorrectly) submitted claim to Medicare coded as COSMETIC . . . Medicare denied all of the $19,610 charge. I appealed and pointed out the miscoding . . . resubmitted to Medicare who paid $1952 (after discount) . . . Medigap G paid $498 balance leaving us owing $0.

Thanks for providing the above examples! I wish there was a tool that would allow us to see the costs for things like that, that way we can compare costs between Original Medicare vs Medicare Advantage. I know there’s no MOOP in the former but there are also no network restrictions and prior authorizations either.

 

[somarco]

Thanks for providing the above examples! I wish there was a tool that would allow us to see the costs for things like that, that way we can compare costs between Original Medicare vs Medicare Advantage. I know there’s no MOOP in the former but there are also no network restrictions and prior authorizations either.

Why are you interested in comparing OM to MAPD? There is no comparison.

OM = deductibles, coinsurance, no OOP cap.
MAPD = copays, coinsurance, high OOP but less than OM alone

OM + Plan G = deductible (B only), OOP = $226 (2023)
MAPD = copays, coinsurance, OOP $5k to $7k

Seems like you are overthinking this. Also, do you have a prospect ASKING about OOP in these scenarios or are you just dreaming about situations like this and pondering what if?

On rare occasions someone tells me they have A only, or A & B, and want to know why they should pay for a Medigap plan.

Door #1 simple answer . . . with A only you pay the hospital per admission $1600 in 2023, plus "full retail" for all Part B type expenses. No OOP cap.

Door #2 with A + B only, you pay $1600 per admission, $220 Part B deductible and 20% above the deductible, no cap.

Door #3 with A, B, Medigap G you are responsible for $226 in 2023.

Which sounds right for you? Door #1, door #2 or door #3?


MAPD has too many variables and there is virtually no way to know your OOP until the claim has been filed and there is no way I would ever estimate/project OOP costs for this situation.

All of the above sounds like an E&O claim waiting to happen.

 

[CaptainPlanet]

Why are you interested in comparing OM to MAPD? There is no comparison.

OM = deductibles, coinsurance, no OOP cap.
MAPD = copays, coinsurance, high OOP but less than OM alone

OM + Plan G = deductible (B only), OOP = $226 (2023)
MAPD = copays, coinsurance, OOP $5k to $7k

Seems like you are overthinking this. Also, do you have a prospect ASKING about OOP in these scenarios or are you just dreaming about situations like this and pondering what if?

On rare occasions someone tells me they have A only, or A & B, and want to know why they should pay for a Medigap plan.

Door #1 simple answer . . . with A only you pay the hospital per admission $1600 in 2023, plus "full retail" for all Part B type expenses. No OOP cap.

Door #2 with A + B only, you pay $1600 per admission, $220 Part B deductible and 20% above the deductible, no cap.

Door #3 with A, B, Medigap G you are responsible for $226 in 2023.

Which sounds right for you? Door #1, door #2 or door #3?


MAPD has too many variables and there is virtually no way to know your OOP until the claim has been filed and there is no way I would ever estimate/project OOP costs for this situation.

All of the above sounds like an E&O claim waiting to happen.

I don’t have anyone asking me about costs, I’m just curious. I’ve seen a few MSN for people that have had extended stays at hospitals or even outpatient procedures/visits and their out of pocket expenses haven’t been as much as you’d expect—and they’re on Original Medicare only, no supp. Leads me to ask how much are these MAPD folk really saving with their plans while they give up control to their insurance carrier in the way of prior authorization and network restrictions.

 

[LostDollar]

I don’t have anyone asking me about costs, I’m just curious. I’ve seen a few MSN for people that have had extended stays at hospitals or even outpatient procedures/visits and their out of pocket expenses haven’t been as much as you’d expect—and they’re on Original Medicare only, no supp. Leads me to ask how much are these MAPD folk really saving with their plans while they give up control to their insurance carrier in the way of prior authorization and network restrictions.

Caveat, not an agent.

I think the underlying question there is whether or not a person is comfortable assuming the risk of uncapped medical expense.

I expect there could be a lot of stories on both sides of an Original Medicare only vs Original Medicare plus Medigap discussion.