Surgery can be frightening and expensive, but at some point in everyone’s lives, it is necessary. Every year 15 million Americans undergo surgery — with many having multiple procedures.
Some surgeries, such as skin grafts or wound debridement, are minor; with doctors performing multiple procedures daily and patients returning home to recover without lengthy hospital stays. Others, such as a coronary artery bypass, fall into the major surgery category and require careful preparation, intense post-operative monitoring, and long recovery periods.
Major and minor procedures also have different cost factors, including the price of the surgery itself and post-operative care. It’s important to know these differences — not only to know what to prepare for but if you’re considering a payment plan as well.
What is a major surgery?
Major surgeries require anesthesia or another form of sedation and artificial support for bodily functions. Because of their invasiveness, these procedures occur in inpatient facilities, such as hospitals.
Inpatient facilities are set up to care for patients after their surgery. Major procedures typically require careful monitoring and care for a day or longer. Staff manage the recovery process and only discharge the patient when they no longer need intensive care and are recovered enough to continue recuperating at home.
Along with the cost of the procedure, the inpatient stay also adds to the overall price tag of a major surgery.
Types of major surgeries
According to Johns Hopkins, some major surgeries are common. These procedures often involve implants, removal of parts of organs or tissue or altering bodily functions. Examples include:
- Coronary artery bypass surgery involves routing a vein around a blockage.
- A mastectomy which removes a part or all of the breasts due to cancerous tissue.
- Organ replacement surgeries involve removing a damaged organ and implanting real or artificial replacement.
- Various heart and brain surgeries often require extensive inpatient care.
- Joint replacement procedures, which involve replacing damaged knee, elbow, shoulder, or hip joints with artificial ones, require inpatient care and extensive physical therapy.
- Amputations which are carefully monitored for infections and blood loss.
- Oral surgeries, such as jaw corrections or bone grafting, are considered major and require post-operative care.
Some surgical techniques, such as laparoscopic procedures, allow doctors to complete some surgeries, such as an appendectomy which removes the appendix, with a small camera and minor incisions. Though the patients may go under general or regional anesthesia, they can return home to recover without inpatient care.
The cost of major surgery
The cost of major surgeries can vary widely, with location, post-operative care, and insurance coverage deciding the overall price tag. For example, the price for a day-long hospital stay in California is nearly four times more than it is in Mississippi.
Aside from location, other factors play a role in the final price, such as:
- Insurance co-pays, deductibles, and coverage maximums;
- Extra treatment and monitoring for pre-existing conditions;
- Complications;
- Type of anesthesia;
- Hospital or surgery center;
- Time spent by the surgeon.
Other expenses, such as physical therapy or other recovery care can add to the overall bill.
Here is the average cost for common major surgeries in the United States according to Statista.
- Heart valve replacement: $170,000;
- Bypass: $123,000;
- Spinal fusion: $110,000;
- Knee joint replacement: $35,000;
- Hysterectomy: $15,400.
Although many insurance plans cover a majority of these costs, patients without insurance have to pay for these procedures out-of-pocket.
What is minor surgery?
Minor surgeries fall into two categories: procedures involving full or partial sedation and those only relying on local anesthetics. However, in both cases, patients return home to recover on the same day as the surgery.
Minor surgeries such as skin grafts may only require local anesthesia or numbing agents.
Sedation procedures could include arthroscopic surgeries performed with tiny incisions and assisted by video cameras or removal of impacted teeth, such as a wisdom tooth extraction.
The one thing minor surgeries have in common is they do not happen at inpatient facilities. If you undergo one of these procedures, you expect to leave on the same day and return home to recover. These surgeries take place at ambulatory surgery centers. These places are not set up for long-term care and patients get discharged within a few hours after their surgery.
Types of minor surgeries
Here are examples of the minor surgeries you might get at an ambulatory surgery center or outpatient surgery clinic.
- A wisdom tooth extraction requiring incisions;
- Arthroscopic surgery to repair knee ligaments;
- Lasik vision correction surgery;
- Tooth implants or other minor procedures performed by an oral surgeon or dentist;
- Cosmetic procedures, such as a rhinoplasty.
Though they are qualified to perform other procedures, many physicians and dentists specialize in specific minor surgeries and can perform several of them in a day.
The cost of minor surgery
Because the procedures are simpler, require fewer specialists and less equipment, and have limited post-operative care, they are cheaper than major surgeries.
Here are examples of what you can expect to pay without insurance coverage, according to Statista:
- Rhinoplasty: $6,500;
- Lasik: $4,000;
- Dental implants: $2,500;
- Arthroscopic knee surgery: $5,000 to $10,000;
- Laparoscopic gallbladder removal: $3,044 to $6,321.
The final bill can depend on your insurance coverage. Many insurers do not cover Lasik, for example, so out-of-pocket costs could be higher than a more expensive procedure partially covered by insurance.
Paying for major and minor surgeries
Different factors can affect the cost of major and minor surgery. If you have to pay for a required surgery, the most important variable in the cost will be how thorough your insurance coverage is.
Several other factors could also come into play.
- The bill could depend on your insurance deductible, which is the amount you pay before insurance coverage pays the remainder.
- Your insurance policy could also require a co-pay, which is a set amount for each office or hospital visit.
- Some policies have maximums for a procedure or annual medical spending.
These factors are outlined in your insurance policy, so you will know how they will affect your final bill beforehand.
Elective vs. non-elective procedures
Whether or not the surgery is a medical necessity will also affect the cost of the procedure and whether your insurance will cover it. Rather than major or minor surgeries, insurers categorize procedures as medically necessary or not medically necessary — both terms differentiate from elective and non-elective surgeries.
All pre-planned surgeries are elective, while emergency surgeries and procedures meant to save your life are non-elective. Under these terms, you can have elective surgery that is medically necessary. For example, gallbladder removal is not a lifesaving procedure, but it can solve chronic pain and help you function normally.
Most insurers and healthcare providers define medically necessary procedures as those that treat a disease or illness according to medically accepted standards.
Medical vs. dental insurance
Insurance policies typically differentiate between medical and dental care. The reason for this distinction is that medical and dental insurance policies have different risk factors. On a practical level, the different policies mean you have to assess how to pay for dental care differently than medical care.
Dental coverage typically includes preventive visits. For example, the policy might cover two cleanings and checkups per year. It will also cover any necessary procedures such as tooth extraction and fillings.
Medical and dental coverage could overlap. If you have an accident, your medical coverage will pay for emergency-room treatments to stabilize your condition. However, dental coverage would pay for implants or any reconstruction work on your teeth.
In-network vs. out-of-network
Insurance providers have a well-defined coverage network including various clinics and hospitals. If you make a doctor’s appointment, you should always check if they accept your insurer beforehand. You may end up paying part or all of the cost for providers who are not within your policies’ coverage network.
In-network and out-of-network distinctions could also apply to hospitals, surgery centers, and even specific surgeons, doctors, or dentists who operate their own clinics. The best strategy is to always stay within your network and opt for a different provider if there are any uncertainties about coverage. You can also work with nearby hospitals, clinics, and dental facilities to see which insurers cover their services. You can then switch your policy to one of these companies.
