How Much Does Bunion Surgery Cost? Comprehensive guide to all surgery related costs from clinic to operating room
Wow!, that is a loaded question, and very difficult to answer. It is kind of like saying what is the average score in a game for an NFL football team. Sure, the average might be somewhere around 24 points, but how often does that actually happen? With that being said, high scores in 50’s for football are rare but low scores are more common, it is much the same way for bunion surgery costs. It is more common to be affordable, rather than extremely expensive. Numerous variables exist that effect that cost, and I will do my best to list them here to help reduce anxiety as you decide to proceed with bunion correction.
Disclaimer: The information in this blog will serve as a general guideline to better understand cost for a patient having Lapiplasty® 3D Bunion Correction surgery and does not include potential cost of repair of other foot problems like hammertoes during the same surgical procedure. Most importantly this is only a general guide as costs can vary widely, based on numerous factors most of which are included below. Dr. Steinke is contracted with insurance providers, and they set the rates for surgery and other services. In other words, this article is intended for educational purposes only, and is not the official cost or rates for surgery. It is merely a guide to let you know potential costs. So lets get started.
3 main areas of cost for surgery/What will surgery cost?
Surgeon fees, anesthesia fees, and surgical facility fees constitute the majority of your out of pocket expenses for 3D Bunion Correction™ surgery. These are the up-front costs that will be incurred just prior to and just after surgery and are the fees that most patients think of when they say, “What will this cost me?” These fees constitute that majority of all patient costs, and when planning for surgery are the most important fees to know.
Below we explain all the areas that are important in determining your responsibility, and yes, it can be very confusing and daunting to determine, but a “average” cost of physician anesthesia and facility fees will be included to get you started.
Much of the information on your potential cost is in your explanation of benefits(EOB) from your insurance provider that can usually be found online. Remember, prices are set by insurance provider not Dr. Steinke or Foot and Ankle Associates of North Texas, LLP. When you come for your appointment with Dr. Steinke you will be told the cost for services that may be administered that day in the office before you see the doctor, so there are no surprises.
So how much will surgery cost up front with insurance?
The simple answer is anywhere from *Zero dollars to $4,500 average with insurance. This is based on surgeon, anesthesia and surgical facility average fees. BUT, if you have met your deductible or your deductible is less than $4,500 dollars it could be much, much less.
While obtaining that number is not extremely scientific, it is based on the following information below listed in the remainder of this article, and cost could be more or less depending on your insurance benefits.
The information is anecdotal based on review of charges from Dr. Steinke’s practice, discussions and review of charges from surgical facilities as well as reported average anesthesia provider fees and is in no way a declaration of patient actual responsibility (lots of disclaimers here, seeing a trend).
surgeon fees($1,500) + Anesthesia fees($1,000) + surgery center fees ($2,000) = $4,500
So how much will surgery cost up front without insurance?
Dr. Steinke and anesthesia providers have standard cash pay rates which are similar to cost of insurance-based care. You will need to contact the facility to obtain their cash fees.
Dr. Steinke’s approximate cash rate for surgery is approximately $2,000 dollars. This can vary as some bunions require fewer or additional procedures for full correction.
Anesthesia and facility fees are billed after your procedure and often payment plans can be negotiated with those providers. Those providers would need to be contacted to get cash prices.
How is my cost of my bunion surgery determined?
If you understand how your benefits for insurance work skip to number 5
1) Office visit copay (range 0 to 150 dollars)
o If you pay a copay to see your doctor, you will likely pay one to see a specialist. A copay is a fee you pay for an office visit, and if no other services are provided it is usually all you pay. To find your specialist copay reach out to your insurance provider for Explanation of benefits (EOB).
o Your initial visit and your pre-operative appointment will be subject to copay. After your surgery, for 90 days, a “global period” exists. During this period copay payments for office follow-up visits will not be collected.
o Services like x-rays, and durable medical equipment like walking boots needed after surgery are sometimes covered under your copay but not always.
2) Deductible
o Deductible is the amount of money you are responsible to pay before your insurance carrier starts to pick up all or some of your costs. Using the Medicare part B deductible example of 233 dollars, after you have paid this amount you pay coinsurance moving forward. For Medicare, once 233 dollars is paid, you are generally responsible for only 20% of service costs. If you carry a secondary insurance, they often pick up that remaining 20% responsibility, and Medicare patients often pay little to nothing for surgery in these cases. Individual deductibles commonly fall around 4 or 5 thousand dollars per coverage year.
3) Coinsurance
o Once you reach your deductible, then your insurance provider will begin to pay a portion of your bills. For the sake of discussion let’s say your deductible is 2,000 dollars, and the cost of a medical bill is 3,000 dollars with a 20% requirement of coinsurance. In other words the insurance provider pays 80% and you pay 20% of bills over your 2,000 dollar deductible. That means you pay 2,000 dollars, fulfilling your deductible, leaving a remaining balance of 1000 dollars of which you owe 20%. That means your total cost is 2,000 + 200 (20% of 1,000 dollars) = $2,200. If your provider has a maximum out of pocket, then they will pay all remaining bills over that amount, meaning you cannot be held responsible for covered services over that amount.
4) Max Out of Pocket(OOP)
o You insurance will typically have a max out of pocket amount. It is the most you can be responsible for during your plan year. If you have met this already this year you will likely owe very little or nothing for your procedure.
5) Surgeon fees
o Dr. Steinke’s office staff will reach out to your insurance company to determine their predetermined cost of your procedure and the office will call you with quote in several business days. To a large degree this is dependent on your deductible, if our deductible has already been met, you may not owe anything for surgery.
o Payment for surgery typically is made at pre-operative appointment and falls around 1,500 dollars on average. Again, it can be more or less depending on your deductible. Medicare patients with secondary insurances often pay next to nothing or nothing at all for surgery.
6) Anesthesia provider fees
o An anesthesiologist will be used for your procedure. Cost of these services can be obtained by patient before surgery and are about 600-1,000 dollars on average per anesthesia event for a procedure under 1.5 hours. Dr. Steinke’s anesthesia providers are in network, meaning if Dr. Steinke takes your insurance they do as well.
7) Surgical Facility fees
o If performed in a hospital setting, generally costs will be higher as the insurance companies allow hospitals to bill patients at higher rates. Dr. Steinke performs his procedures at surgery centers, creating a much smaller financial burden on patients, and at the same time providing a lower infection risk. Charges for the procedure at a surgery center for Lapiplasty® are around 7,000 dollars on average, but patients typically only pay around 2,000 dollars out of pocket due to their insurance providers picking up much of the cost.
8) Follow-up visits(90 day global period)
o After your procedure for 90 days you do not have to pay for office visits. X-rays will be required at 4-5 visits during your recovery and typically can range from zero dollars if covered under your plan, or on average in our practice about 35-40 dollars each time they are taken. No fees will be incurred for a radiologist to read the images like in the hospital setting.
9) Durable Medical equipment (DME)
o Knee scooters: sell for around 100 dollars on major online marketplaces. They can also be rented for around 75 dollars for 1 month. Insurance carriers sometimes will reimburse this cost. Patients often are able to find one for free from a friend. You can use just crutches if you want but long-distance travel is much easier with a scooter.
o Walking boot: is billed to insurance and may cost you nothing, or around 170 dollars based on insurance prices. A new clean unused boot is required to prevent infection risk and properly support the foot…sorry, that means no hand me downs.
o Crutches: can be purchased at a local pharmacy or online for about 35 dollars. These will be used primarily to assist walking in the first few weeks after surgery.
A tall walking boot will be needed from day 1, items like compression sleeves will be used after post-operative dressings are removed
10) Over the counter items(OTC)
Over the counter items will be needed after surgery like nylon compression sleeves for swelling, toe spreaders and possibly bunion splints to maintain toe alignment through recovery. Not every patient needs these items, and even if all items are needed would be less than 100 dollars. Patients can provide these items on their own if they wish.
11) Physical therapy
o All patients are recommended to attend physical therapy to aid in restoring full range of motion to great toe, as well as reduce swelling. Patients should do at least a few sessions, but several times a week for a month is recommend to aid in quick return to activity. Copays and office visit costs for therapy vary by patient, call your insurance carrier for therapy Explanation of Benefits(EOB).
12) Orthotics or inserts
o You will transition to an athletic shoe after 6 weeks. At this time the bone is “healing,” not “healed” and extra support is recommended to ease and expedite recovery. In best case scenario a custom orthotic provides the best support, and potential cost is subject to your insurance carrier. Cost may be as little as a copay for your visit, or around 550 dollars if you have not met your deductible or have no benefit for this device. A quality over the counter insert range from 50 to 80 dollars and can be purchased at the Dr. Steinke’s office if you do not wish to get custom orthotics.
So that is a long and tedious list, but if you understand your insurance benefits you can determine cost for procedure by simply adding each category listed above. If you come into the office for a consultation Dr. Steinke will have your benefits verified prior to surgery, and his staff can answer any questions you have before proceeding with a procedure. The anesthesia provider and facility can discuss your fees before surgery as well, no surprises here.
Please call our office to make an appointment and after examining you to decide if Lapiplasty® is right for you, we can get you the information you need to proceed with financial confidence.