How to Calculate the Cost of Medical Procedures

Calculating the cost of medical procedures is a tricky task. Most people typically underestimate out-of-pocket costs after health or dental insurance kicks in, even with common procedures and specialized operations. Of course, there are reasons for this problem. Anything can happen during a procedure. A patient might have bleeding or blood pressure difficulties during or after a surgery that results in more extensive and expensive after surgery care. A patient who receives a gastric bypass, for example, might experience a bowel obstruction that requires expensive treatment. Too many different and competing methods of billing currently exist, and it seems like health insurance companies and hospitals have conspired to make their billing process all but impossible to understand — much less predict.

Given these facts, the best you can do is calculate the standard estimated cost of a certain medical procedure based on a best-case scenario.

Billing Methods

Before a patient can correctly calculate an estimate of their final out-of-pocket expenses, they must request an itemized price list that outlines line-by-line the typical costs for a procedure. You should always take into consideration and request not only the doctor’s charges but also any extras like supplies and facility fees. Keep in mind that some doctors charge bundled rates for procedures as well, which means that you might receive a bill that has a mix of line items and bundled rates.

Simple Math

Once you have all of this information, you simply subtract the amount of agreed upon coverage from your health insurance company from the total estimated cost. Many people must pay a deductible before their insurance kicks in. You should add the deductible amount to your total out-of-pocket costs unless you’ve already paid it earlier in the year for other medical procedures. Don’t forget that a health insurance company usually pays less to out-of-network providers. This means that you pay more if you choose to have a procedure completed by an out-of-network doctor or at an out-of-network facility.

Other Considerations

The cost of a medical procedure goes beyond the bill you receive from your health care provider or hospital. Medical procedures, especially surgeries and rare treatments, usually involve additional out-of-pocket costs, such as money for gas and car maintenance or public transportation fees to and from a facility before and after the procedure. If you’re traveling long distance, you must also take into account lodging and food expenses. Your insurance might not cover specialized equipment used during recovery or over-the-counter drugs and supplements. On the other hand, healthcare providers also give patients discounts for paying off their bills immediately or in cash or belonging to a certain type of social or professional group. If you are receiving treatment for a work injury, you may qualify for worker’s compensation payments, which can help offset some of the costs.

Dental Procedures

Many insurance companies refuse to cover fully or at all a wide range of dental procedures. Thankfully, if you need an orthodontic procedure, for example, an orthodontist can usually provide you with an accurate upfront average estimate. If you need dental implants, the estimate becomes more complicated because there are several different factors that affect the cost of dental implants. You should always confirm the amount covered by both your health and dental insurers in writing so that you can correctly estimate your costs since one company might cover certain aspects of the procedure while the other company covers other aspects. Other dental procedures include getting invisalign or braces for your teeth.

Of course, it’s again important to remember that you can never have a 100 percent accurate picture of potential out-of-pocket costs when performing medical procedure calculations. After a procedure, you should also always request a final line-by-line itemized bill from your healthcare provider and insurers. Followup billing statements make it possible for you to compare your original estimate to the final costs that resulted from after-procedure care. You can also use them to check for billing errors.

Looking for other health-related calculations? Check out our curated list of helpful health calculators here!

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