The decision to undergo hip replacement surgery is one that needs to be made very carefully and with as much information as possible. Among the many other factors that go into the decision-making process, hip replacement cost is a key consideration. It’s important to understand the facts about cost and how this complex topic should fit into the wider discussion of reaching your long-term pain relief goals.
To help you be more engaged as you work with treatment and health insurance professionals, we’re happy to share the following general overview of facts surrounding hip replacement cost. If you’d like to learn more about the specifics surrounding the total hip replacement surgery we perform at Outpatient Joint Replacement Center of America, don’t hesitate to reach out with any questions. Our primary goal is to help you get back to the people and activities you love on the most cost-effective basis possible.
What to Know About Hip Replacement Cost
Hip replacement cost varies depending on a wide range of factors, including the surgeon, facility, diagnostic tests, surgical implants, geographic location and the complexity of the procedure itself. According to health care industry cost aggregator CostHelper Health, the average cost of a total hip replacement surgery for an uninsured patient is close to $40,000, with costs ranging between approximately $31,000 and $45,000. In some cases, facilities and surgeons may offer a discounted rate for patients paying fully out-of-pocket for a procedure.
It’s important to understand that these hip replacement cost figures are for uninsured patients and is not what most patients with health insurance will end up paying in out-of-pocket costs. As anyone encountering health insurance-related and/or Medicare-related cost questions knows though, determining a patient’s out-of-pocket costs depends on a highly complex array of elements.
What to Know About Health Insurance Coverage for Total Hip Replacement
The goal of health insurance is to limit costs for the insured and the health care system in general by pooling resources and negotiating costs through a centralized payment organization. Many patients have health insurance coverage through an employer, and uninsured patients have access to private insurance plans on state-based health care marketplaces created through the Affordable Care Act. Medicare is a state-funded system for retired and some disabled patients, where the federal government provides coverage and acts as a payer.
Patients with private health insurance typically pay a monthly premium that gives them coverage. Insurance plans then have a deductible, which is the amount of expenses that must be met by out-of-pocket costs before insurance coverage kicks in. After that, the health insurance coverage will be a coinsurance, where the provider pays a portion of expenses, such as 80%, until an out-of-pocket maximum is reached.
Furthermore, most health insurance plans, as well as Medicare, work with a dedicated network of providers that they have negotiated certain rates with. Treatment costs, including hip replacement costs, are highly dependent on whether the surgeon and facility are part of your insurance carrier’s provider network.
All of these specifics vary widely on a plan-to-plan and state-by-state basis. Some plans may have a low premium with a very high deductible or vice-versa. In other cases, employee-sponsored plans may provide coverage that results in little-or-no out-of-pocket costs for patients, but there may be a more limited selection of providers. This is why hip replacement costs have such a broad range and are often so complex to determine.
When determining if undergoing hip replacement surgery is the right and practical decision for you, make sure you have all the necessary information about your specific insurance plan and whether a prospective surgeon is in-network. Sorting out these basics early in the process can make preparations more smooth as you get closer to the procedure.
Balancing Hip Replacement Cost With Other Considerations
Cost is a very important part of deciding to undergo a procedure such as total hip replacement, but it shouldn’t constrain you or override factors that can be more important than money over the long term. For example, the search for an experienced and qualified surgeon to perform your hip replacement should be conducted as independently of cost considerations as possible.
Finding an orthopedic surgeon you trust, who has extensive experience in treating your specific condition and who can perform a procedure designed for a faster recovery and a better outcome represents a very high degree of value that should be factored into your cost criteria.
Other factors to consider are hospital-associated costs for an inpatient procedure versus the ability to undergo an outpatient procedure at an ambulatory surgery center. Many patients opt for outpatient total hip replacement if possible due to the streamlined patient experience it offers.
Additionally, patients who decide to postpone or delay hip replacement should also be aware of the monetary and non-monetary costs of avoiding surgery when it’s the recommended course of action. Conservative treatment is highly effective and is generally the first line of therapy for pain relief in many cases, but doctors will tell patients to consider surgery if nonsurgical treatment has been exhausted without bringing a needed improvement in quality of life. Continuing to pursue physical therapy and injections if they are having diminished effect on pain relief can result in high costs over a period of months or years.
Avoiding hip replacement surgery may also result in a negative effect on your ability to work, your relationships and your enjoyment of leisure activities. Although these areas may be more difficult to quantify, they should be weighed as carefully as possible when thinking about hip replacement cost.
Due to the high variation of factors that influence the cost of hip replacement surgery, it’s crucial to work closely with a prospective surgical provider to get your questions answered. Surgeons and their staff should take a transparent approach to the full treatment process. This includes educating you about your condition and treatment options and helping you understand cost and insurance coverage.
The OJRCA Approach to Total Hip Replacement
The OJRCA team and board-certified surgeon Dr. Philip Clifford utilize state-of-the-art techniques and unique multimodal pain prevention and anesthesia protocols to enable total hip replacement surgery on an outpatient basis. Even patients requiring a hospital-based procedure due to the presence of certain medical conditions can still benefit from these techniques.
We are committed to the highest level of patient care on a cost-effective basis and work with a wide range of payment methods and insurance carriers. One of our caring representatives will be happy to answer any questions you have about hip replacement cost, no matter where you are on your treatment journey.
Contact us online today to learn more. Or call us at 813-492-4662