Yes, you can price shop for surgery!

It’s not your grandma’s knee replacement or your father’s shoulder repair. With surgery, it’s a whole new world.

“Things have changed in surgery. Techniques are different than they were 20 years ago, and so are the places where surgery is performed,” says Bryce A. Johnson, M.D. He’s an orthopedic surgeon in Orange County, California.

Another big change: People shop around to find the best — and most affordable — surgery. And why not? After all, if you had a leaky roof, you’d look for the best contractor at the best price. The same rules apply when it comes to your health.

Take joint replacement: In 2019, more than 1.2 million Americans got new knees or hips, with price tags for the procedures ranging from $5,000 to $30,000. That’s a significant difference in cost.

Surgery may not be a day at the beach, but if you do your homework, you can make the experience less stressful — and a lot less expensive. Here’s how:

1. Talk with your doctor

Need surgery? One of your first questions should be: How much is this going to cost? For a non-emergency procedure, you can (and should) feel comfortable talking with your doctor about money.

“There’s nothing wrong with saying, ‘Because of my high deductible, this is coming out of my pocket — every test and treatment I get will be a check that I have to write. Can you help me understand the pros and cons of not doing this?’” says AnnMarie McIlwain, CEO of Patient Advocators in New Jersey.

Let your doctor know that price is a concern, and work together to find the best, most affordable solution. Remember: It all begins with an honest conversation. (And while you’re at it, don’t forget to ask for your procedure’s CPT code [current procedural terminology] — that identifies exactly what you’re having done.)

Next, ask your doctor where they’re credentialed to perform the surgery, advises Nicole Broadhurst, Chief Medical Billing Advocate for Tennessee Health Advocates. That can play a big part in your surgery’s expense. “Many times, surgeons will be credentialed at multiple locations,” she says. That piece of information can help guide your decision too.

If your doctor won’t respond to your questions, it might be time to shop around for another provider. “Talk to people,” advises Broadhurst. “Ask, ‘Who do you know who’s had their knee done and had good results?’ Shop for a doctor the same way you’d shop for a contractor or a mechanic.”

2. Find a facility

These days, you’re likely to use an outpatient facility for surgery instead of checking into a hospital. It could be a hospital outpatient department (HOPD), or it could be a freestanding facility known as an ambulatory surgical center (ASC).

The latter is a healthcare clinic that’s not connected to a hospital but provides outpatient surgery and preventive care, such as colonoscopies. ASCs offer effective care, great results, and prices that are way lower. For the right patient (somebody who’s fairly healthy) and the right procedure (one that’s not too complex), shifting the location of your surgery to an ASC can save about 59%. (A good place to start comparing prices for procedures are websites like Turquoise Health, where you plug in your ZIP code and CPT code and get a list of facilities in your area and what they charge.)

“An ambulatory surgery center is set up to get you home safely the same day,” Dr. Johnson explains. “Their systems and protocols all optimize that discharge, help control pain, and make you as comfortable as possible. Patients have a better experience and a smoother recovery.”

And you don’t have to sacrifice quality for price. In a 2018 study published in Health Policy and Economics, ACSs scored the same as — or higher than — HOPDs for the very same procedure. “In an ambulatory surgical center, you can get a procedure that’s just as good as or better than the hospital,” says Dr. Johnson. “The operating room looks the same, and the teams are trained the same way. If you took a tour, the only difference you’d notice is that it’s in a freestanding structure.”

ASCs are carefully regulated by state and federal agencies. For example, all facilities that do surgeries for Medicare patients must have the approval of the Centers for Medicare & Medicaid Services (CMS). Most also have certifications from professional organizations such as the Joint Commission and the American Association for Accreditation of Ambulatory Surgery Facilities.

The doctors at ASCs specialize in a certain kind of surgery — such as joint replacements or athletic injuries — so they’re really good at what they do. A 2018 review of more than 600 shoulder surgery cases was published in the Journal of the American Academy of Orthopaedic Surgeons. It found that when these procedures were performed at an ASC specializing in shoulder surgery, they took 39% less time than they did at an HOPD.

Another study compared results of people who received knee replacement surgery at an ASC with those who had it at an HOPD. At ASCs, patients had a lower risk of postoperative complications, readmission, or visits to the emergency room.

Even better, ASC patients gave their experience super high scores. A survey by the CMS published in 2022 showed that 97% reported that ASC facilities were clean and that staff cared for them and communicated with them in a professional way.

ASCs aren’t for everyone, though. “I may have a patient who isn’t a good ASC candidate,” says Dr. Johnson. “They may need a more complex surgery, or they may not be comfortable psychologically with that setting.” Work with your doctor to decide the best place for you.

3. Compare costs

The best place to start is to call your insurance representative or go to your plan’s website. You’ll find a wealth of information about in-network providers, hospitals, and surgery centers as well as typical charges. Using your CPT code, you can find what you need to make an informed shopping decision. Plus, you’ll learn how much your plan will pay toward your care and what your financial responsibility will be.

Other sources of information:

• Hospital websites: Look for the “pricing transparency” page to get costs for your surgery. Price transparency rules put into place in 2021 require hospitals to provide clear pricing information on their websites. Unfortunately, compliance is only at 14.3%, according to a report from Patient Rights Advocate.
• Check out sites that compare costs by geographic area, such as these:
  • Guroo. While it doesn’t provide specific prices for your hospital or clinic, it will help you find the average rates within your state. That can be useful for price shopping.
  • Fair Health Consumer. This search tool crunches billions of private health claims to provide price estimates on more than 10,000 services.
  • ClearHealthCosts. It allows you look at prices from specific clinics and hospitals as reported by users, healthcare providers, and reporting databases.
  • Healthcare Bluebook. This is a pay-to-use tool, but the free version allows you to make 10 searches a month.
• Contact a freestanding clinic. These facilities generally focus narrowly on a specific set of services. Try a Google search for “freestanding clinics” in your zip code.

“It’s always cheaper to do any kind of medical service outside a hospital,” says Broadhurst. “The most expensive place to do anything is to go to the hospital. And now, with changes in the way we share costs with insurance companies, the patient is responsible for more dollars than ever before. It really is a big deal.”

Shop for your surgery the same way you’d shop for any other big-ticket item. A little legwork can really pay off.

Additional sources
Why joint replacements have different costs at different facilities: Modern Healthcare
What is an ASC?: Ambulatory Surgery Center Association
Federal Requirements Governing ASCs: Advancing Surgical Care
Safety of outpatient shoulder surgery at ASCs: Journal of the AAOS
Outpatient and ambulatory surgery consumer survey assessment: The Centers for Medicare & Medicaid Services