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Posts for tag: surgery center costs

   Foot surgery is often not considered to be MAJOR my many people.  Some of it, can actually be classified as MINOR surgery - especially that involving toenails, warts, cysts, and other surgeries involving a small incision or no incision at all.  There are foot surgeries done under LOCAL ANESTHESIA only, surgery done under GENERAL ANESTHESIA, and that which is classified as LOCAL with SEDATION.  While surgery under General Anesthesia is usually peformed in a hospital or surgery center, that done under LOCAL ANESTHESIA, whether done with or without sedation, can often be done in the DOCTOR'S OFFICE (if adequately equipped) OR in a hospital OR in a surgery center.  In many cases, the patient can choose one location over the other, but in far too many cases, the choice of the surgery is up to the surgeon, and the patient has little or no say in the matter.  

    Hospitals are typically the most EXPENSIVE option, and although most hospitals are well equipped to deal with potential complications or emergencies that may arise during the surgery, the most dangerous and immediate complications have to do with ANESTHESIA.  At one time, patients were admitted to the hospital the day before surgery, and then often spent one or more nights in the hospital after surgery.  All of that changed, starting back in the 1980's, when managed care became the buzzword, and the cost of being in a hospital, especially inpatient, became exorbitant.

   Surgery centers are usually less expensive than a hospital.  They still allow the patient to spend some extra time there postoperatively, especially if the patient takes some time to recover from the anesthesia.  Again, local anesthesia can, and often is used, for foot surgery.  Local anesthesia with IV or oral sedation can also be used.  In some cases, general anesthesia can also be used.  Surgery centers, however, are not the "bargain" that they appeared to be when they started springing up in the 1980's and 1990's.  The cost of the OR itself, the anesthesia, pathology lab to examine whatever specimen(s) is removed, the radiology (x-rays often done PRE- and POST-OP), along with ALL of the supplies used are itemized, just like in the hospital....and they must be paid either by YOU or YOUR INSURANCE COMPANY!   The surgeon's fees get paid to the surgeon whether in the office, hospital, or outpatient surgery center.  On top of all of that, MEDICAL DEVICE MANUFACTURERS sell most of their devices to the surgery center or hospital, and they pass the cost along to the patient!   Implants, which in foot surgery include such things as bone plates and screws, staples, pins, wires, etc. vary WIDELY in cost.  A k-wire can often be used to hold a toe in position when a hammertoe surgery is performed, but medical device manufacturers have come up with "new and improved devices" to hold the toe in position.  While some of these are nice devices, and they make the surgery more challenging and  interesting for the doctor, and have some benefit in healing - in certain cases, the cost can vary from $4 or $5 for a single K-wire to $1800 and sometimes $2000 or more for a really modern state-of-the-art device that can be a nightmare to remove if it ever becomes necessary to remove it.  So - add up the anesthesia fees, the radiology fees, the use of the OR (based on how long the surgery takes), the more expensive fixation devices used, along with additional lab fees, etc. - and that hammertoe surgery, for which the doctor may get a few hundred dollars, now becomes several thousand dollars!  "But my insurance will cover it" you say.   Maybe - maybe not.  Or maybe they will cover THIS surgery, but when it comes time to renew your health insurance, the premium is much higher each month, OR - they no longer cover "this type of surgery."

    I have seen patients have SOFT TISSUE SURGERY - repair of a tendon in one case - under LOCAL with SEDATION - where the total cost, including the surgery, anesthesia, supplies, labwork, etc. was nearly $30,000 !   And in this particular case, the patient had NO insurance.  If he had that same surgery done in the office - the "fees" would have been paid for - or "absorbed"  by the doctor.  That type of surgery would have been less than $1500, in fact, possibly less than $1000.  But instead - he is paying the surgery center every month until his bill is paid off.   Now.....what if he had health insurance?   First off all, he probably would have had a DEDUCTIBLE.  He may have had to pay $3000 or $5000 or more before his insurance would pay anything.... and then maybe he would have an 80/20 plan.  That means insurance would pay 80% After the deductible, and he would pay 20%.   So....let's just say he had a $2000 deductible - actually pretty good nowadays - and his insurance paid 80% of the APPROVED amount.  Well they probably would not approve $30,000.  Let's say they approved $20,000.  He would have paid $2000 deductible PLUS 20% of the remaining $18, that is $3600. So when all is said and done, he would have STILL Paid $5600 for a tendon repair.  The insurance would have paid $14,400.  But if he went to a foot specialist with an OR in the office, he would have paid UNDER $1500.  Yes - the insurance would have paid $0.  I can tell you that my fee for that procedure, done in office would have been no more than $800.  Maybe less.   Even if he went to a doctor that charged a fee for the use of the in-office OR and anesthesia, MAYBE it would have been $1600 or $1700.  

    Sometimes "NEW and IMPROVED" is better.  Often times it is not.  If you are having foot surgery done - ask where the surgery will be done.  If done in the office, the doctor can give you a pretty good idea of the cost, and for how much you will be responsible.  He or she can't really do that if it is done in the hospital or surgery center.  Ask if it can be done in the office, and if so, can you be sedated at all or is it just local anesthesia.  If you are "pushed" into having the surgery at a certain surgery center, you may want to find out why?   Does the doctor have "ownership" in that surgery center?   If so, you can be sure the amount of money he or she will make off of doing the surgery will be far less than what the surgery center will make, but wait...that means the doctor will get some of that money also.  And there is nothing wrong with that.   It is perfectly legal, and he or she has a right to that money.  That doctor has invested in that surgery center and has a right to be compensated.  But, YOU,  as a patient just need to know.  You have a right to decide where your surgery is done.   You have a right to know how much you are going to be responsible for financially, because in this day and age insurance will only cover so much.  The days of "my insurance will pay it all" are over!


Richard S. Eby, DPM
Eby FootCare and Laser Center

7348 East Brainerd Road

Chattanooga, TN.  37421