Depending on the surgery, the out-of-pocket cost can range between $4,000 to $170,000. The most expensive surgery is heart transplant. LASIK eye surgery and other elective procedures may cost less. Factors like where you get the surgery done, the type of surgery you're getting, and pre or post-surgery care will impact the cost.
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Understand Elective vs. Non-elective Surgeries
Elective Surgery: This category includes surgeries that are planned and are not for life-threatening conditions. Examples include cosmetic surgery, joint replacements, or cataract surgery. Insurance coverage for elective surgery can vary greatly. Many elective cosmetic surgeries are not covered by insurance unless they are deemed medically necessary. Pre-authorization from the insurance company is usually required.
Non-Elective Surgery: This category includes emergency surgery, which is performed in life-threatening situations, and medically necessary surgery, which is required to treat a health condition but is not an immediate emergency. These surgeries are generally covered by insurance, subject to policy terms. Emergency surgeries are typically covered without pre-authorization due to their urgent nature. For medically necessary surgeries, pre-authorization is often required to confirm that the procedure is covered.
Cosmetic Surgery: cosmetic surgery is considered non-elective. However, there are exceptions such as breast reduction and reconstructive surgery when deemed medically necessary.
Difference: the key difference in coverage between elective and non-elective surgeries is often the degree of medical necessity. Insurance policies are more likely to cover surgeries that are essential for a patient's health, while elective procedures, especially those for cosmetic purposes, are less likely to be covered or may have more limited coverage.
Cost of Surgery Without Insurance
Paying for surgery out of pocket can vary greatly, costing you between $4,000 and $170,000, depending on what surgery you get. LASIK eye surgery may cost you about $4,000 because the surgery is less intensive, takes less time to perform, and can be an outpatient procedure, which is less expensive when compared to inpatient procedures.
However, more extensive surgeries such as a heart valve replacement or heart bypass are more expensive for the following reasons:
- Pre and post-operative hospital stay. Before and after receiving surgery, you will likely have to stay in the hospital. This is to make sure you are prepared for the surgery and are recovering well after. The average hospital stay is 6-7 days for bypass surgery.
- Pre-surgical treatment. Pre-surgical treatment is done to increase the success of the surgery; this may include catheterization and other treatments necessary to ensure that bypass surgery is successful.
- Anti-rejection medication. Anti-rejection medicine is necessary to prevent your body from rejecting any new organs, arteries, or valves after surgery. It may be prescribed for transplant surgeries as well.
Elective Surgeries
| Surgery Type | Cost |
|---|---|
| Hip Replacement | $40,364 |
| Knee Replacement | $35,000 |
| Hip Resurfacing | $28,000 |
| Gastric Bypass | $25,000 |
| Cornea | $17,500 |
| Gastric Sleeve | $16,500 |
| Hysterectomy | $15,400 |
| LASIK | $4,000 |
| Cataract Surgery | $3,500 - $7,000 |
| Varicose Vein Treatment | $600 - $3,000 per leg |
| Carpal Tunnel Surgery | $2,000 - $4,000 |
| Bunion Surgery | $5,000 - $13,000 |
| Tonsillectomy | $4,000 - $6,000 |
| Tubal Ligation | $1,500 - $6,000 |
| Hemorrhoid Surgery | $3,000 - $6,000 |
Non-Elective Surgery
| Surgery Type | Cost |
|---|---|
| Heart Valve Replacement | $170,000 |
| Heart Bypass | $123,000 |
| Spinal Fusion | $110,000 |
| Angioplasty | $28,200 |
| Spleen Removal | $47,860 |
| Replace or Revise Brain Shunt | $49,355 |
| Cranial Lesion | $50,189 |
| Ileostomy | $51,683 |
| Removal of Pacemaker/Defibrillator | $52,005 |
| Partial Removal of the Colon | $52,353 |
| Gallbladder Surgery | $54,041 |
| Appendectomy | $33,000 - $48,000 |
| Emergency Cesarean Section (C-Section) | $7,500 - $14,500 |
| Brain Surgery for Tumor Removal | $100,000 - $150,000 |
| Lung Transplant | $800,000 - $1,200,000 |
| Heart Transplant | $1,000,000 - $1,400,000 |
| Emergency Fracture Surgery (e.g., Hip) | $15,000 - $35,000 |
| Trauma Surgery (e.g., for Car Accident) | Varies widely based on injuries |
| Bowel Obstruction Surgery | $30,000 - $120,000 |
| Emergency Aortic Dissection Repair | $180,000 - $250,000 |
Cosmetic Surgeries
| Surgery Type | Cost |
|---|---|
| Rhinoplasty (Nose Job) | $6,500 |
| Breast Implants | $6,400 |
| Liposuction | $3,500 - $8,000 |
| Tummy Tuck | $8,000 - $10,000 |
| Facelift | $7,500 - $11,000 |
| Eyelid Surgery (Blepharoplasty) | $3,000 - $5,000 |
| Breast Lift | $4,500 - $6,000 |
| Botox | $200 - $400 per session |
| Dermal Fillers | $600 - $1,000 per syringe |
| Chemical Peel | $600 - $900 |
| Hair Transplant | $4,000 - $15,000 |
