The average cost of shoulder surgery ranges from around $6,000 to $22,000. Occasionally, a shoulder surgery can cost up to $50,000, but that is unusual.
The amount patients who have health insurance have to pay depends on their insurance deductible and copay. Insurance plans vary greatly and my staff will work with you and your insurance company to determine what your out of pocket expense will be.
There are several different types of shoulder surgeries, and the cost will vary depending on exactly which procedure your condition requires. The cost will also vary depending on the types of implants used and and where your procedure is performed.
Insurance Copays and Deductibles
Most health insurance plans do cover shoulder surgery, but the out-of-pocket expenses to the patient vary widely. A good place to begin your research is to familiarize yourself with your insurance company’s schedule of benefits, which is usually available online.
Most insurance policies require the patient to pay a specific amount prior to benefits starting to pay for anything. This is referred to as your “deductible”. After your deductible is met, most policies will pay a percentage of your bill, and you will be responsible for the remaining balance.
It would be a very good idea to call your company for clarification to make sure you thoroughly understand the coverage.
Most surgeon’s offices and surgical facilities will determine your out of pocket expenses for you so that there will be not surprises. As you plan your surgery, keep in mind that patients are required to pay the deductible for shoulder surgery up front.
Are There Extra Costs?
Anesthesia is necessary for shoulder surgery and is often billed separately. On average, the price for anesthesia starts around $600 for a surgery that lasts between 30 minutes to an hour.
Invasive shoulder procedures, such as a total shoulder replacement or a reverse shoulder replacement, may require your procedure to be performed in a hospital.
The charges for procedures at the hospital are typically more complicated and require more expensive implants. Additionally, the baseline charges for procedures at hospitals is much higher for the same procedure performed at a Orthopaedic Surgery Center.
Additionally, there are some newer techniques that are considered experimental and not covered by insurance. An example of this is a “superior capsule reconstruction” for an irreparable rotator cuff tear, or the addition of orthoobiologics (Bone Marrow Concentrate, Umbilical Tissue, PRP) to aid in your healing. Choosing to undergo these procedures is an individual decision and is predicated on acknowledging that the cost is yours and will not be submitted to insurance.
Some surgeries will require medication for a few weeks post-surgery. This cost is usually minimal and often covered by insurance.
Physical therapy after surgery is very important to your recovery. The length of time you will spend in physical therapy and the cost will depend on the type of surgery you need. Most health insurance companies will help with the cost while having you contribute a copay per session. The cost of a copay varies greatly between insurance companies.
Ultimately, the responsibility for the cost of the surgery lies with the patient. Being proactive will enable you to make the best choices as you budget for your surgery.
Our office will give you a pre-treatment estimate of all your surgical costs. Our staff is dedicated to making sure you are fully informed. We want to take the mystery out of this complex process and make it understandable.
Some costs that we’ll go over with you:
- Hospital / Surgery Center
- Implants or Prosthesis
- Tests (Radiology, Pathology)
- Postoperative Care
This estimate allows you to check with your health insurance company to make sure you fully understand what your total out-of-pocket expense will be.
Don’t be afraid to ask questions about something you don’t understand.