The only thing worse than needing knee surgery is getting your medical bill. Knee surgery can be one of the most expensive outpatient surgeries to have. This articles describes medical bill tips that are specific to arthroscopic knee surgery.
1) Site-of-service cost difference
On the cheap end, some insurance companies have negotiated arthroscopic knee surgery prices at ambulatory surgery centers as low as $1,200 for a meniscal repair and $3,400 for an ACL repair. On the expensive end, facility fees for some outpatient hospital departments are as high as $6,000 for a mensical repair and $16,000 for an ACL repair. ACL repairs are more expensive than meniscal repairs because of the human tissue graft used. The human tissue from a cadaver can cost the facility $1,000 or more to acquire for your surgery.
The hospital or ASC may bill your for implantable devices if your physician uses high-end screws or hardware. If you have insurance and the facility is billing you for device costs above and beyond your deductible and coinsurance, call your insurance company and ask if these device costs were "bundled" in the insurance payment to the facility. The vast majority of the time, you should not have to pay separate for devices unless you agreed to do so before hand with your physician. The hospital or surgery center should have not used "patient billable" materials without informing you.
2) Surprise costs
With knee surgery it can be difficult to estimate the price because the surgeon may find unexpected damage that needs to be fixed once he or she gets inside your knee. Ask each provider what the different costs could be if the surgeon finds additional damage and has to do additional procedures.
3) Consider physical therapy benefits and costs
Depending on what type of surgery you have, physical therapy could start the same day. Check you benefit plan to make sure you know how many visits are allowed as well as the coverage rate and copay. For example, you may have anywhere from 10 to 20 allowed physical therapy visits in a year and your copay could be anything from $25 to $65 for each visit. Factor these costs into you budget. If you're experiencing financial hardship, you should explore whether there are any hospital-based physical therapy clinics that may have more charitable billing practices.
If you run out of allowed visits for physical therapy, you can still see the therapist on a cash-basis. Ask the therapist what his or her rate is for self-pay patients.
4) Mitigate need for second surgery
You can avoid paying extra costs after the surgery by reducing your risk of re-injury. There is a risk that if you don't do your physical therapy or if you try to return to athletic activities too quickly that you could need the surgery again. Unfortunately, re-tearing the knee is pretty common, especially among athletes and teenagers that try to return to sports too quickly.
5.) Ask your employer about disability benefits
ACL repairs are expected to begin physical therapy the same day, but if you have a meniscus tear, you could be looking at some serious recovery time. You may be entitled to payments equal to 60%-70% of your salary while you are recovering from surgery and unable to work. This is a great benefit to have if your recovery time from surgery will consume a significant portion of your vacation time or paid-time off. Short- and long-term disability insurance are commercial insurance benefits that you can use to pay bills when you cannot work for medical reasons. AFLAC is an example of short-term disability insurance.
Contributed by Nicholas Newsad, M.H.S.A., author of Medical Bill Help and The Medical Bill Survival Guide.
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