Six Strategies for Minimizing Carpal Tunnel Surgery Costs
Carpal tunnel surgery (cpt 64721) is a very common orthopedic/hand surgery that is traditionally performed in hospitals and ambulatory surgery centers.
When I was first learning about carpal tunnel surgery, I’ll never forget that the man who was telling me about it mentioned that it could be administered under what I thought he said was called “beer block” anesthesia. That sounded great to me at the time, but I quickly learned that having carpal tunnel surgery is neither fun to have or fun to pay for. Here are six strategies for minimizing carpal tunnel surgery costs:
1) ENROLL IN ONLINE ACCESS TO YOUR HEALTH INSURANCE PORTAL
All major insurance carriers give their enrollees online access to their benefit plan, a list of in-network providers, and the explanations of benefits (EOBs) for all services they have received. I strongly encourage you to sign up for internet access to these services in advance of your carpal tunnel surgery. It is always free and normally only takes a few minutes to set-up. All you need is your benefit card.
Having access to EOBs can come in handy after carpal tunnel surgery because it allows you to see the correspondence between the insurance company and your healthcare provider, how the insurance company applies your benefits to the hospital bills, and how they calculate the patient liability portion.
2) EXAMINE YOUR BENEFIT PLAN FOR OUTPATIENT SURGERY
Find your benefit plan summary and identify your deductible as well as your coinsurance and copayments coverage rates for having outpatient surgery in an ambulatory surgery center (outpatient surgery center) versus having outpatient surgery in a hospital.
Your deductible is especially important to know when planning for carpal tunnel surgery costs, because patients frequently have to pay down their entire deductible for this procedure. You have to pay 100% of your deductible costs, before the insurance company will begin paying anything. So if you have a $2,000 deductible, and you or your spouse needs carpal tunnel surgery on both wrists, I would say it is very likely that you will have to pay the entire $2,000 deductible.
The coinsurance coverage rate may differ between ambulatory surgery center and hospital setting or the coverage rate may be the same. Let us assume that the same coinsurance coverage rate applies for outpatient surgery whether it is performed in an ambulatory surgery center or a hospital. For example, if you have a 70% coverage rate then your insurance covers 70% of the cost, and you have to pay the remaining 30% of the cost.
The total carpal tunnel surgery costs in an ambulatory surgery center are almost always lower than the total costs in a hospital. If you have coinsurance, you want the total costs to be lower because your coinsurance portion increases as total costs increase.
3) CARPAL TUNNEL SURGERY COSTS FROM THE ACTUAL MATERIALS USED
The surgical supplies used during carpal tunnel surgery cost about $120. The most expensive component of these costs is the $30 hand pack with the drape. I think it’s pretty wild that patients will usually have to pay a $1,000 deductible or more despite the fact that the procedure is only 30-35 minutes in length and the supply and material costs are only $120.
4) SITE OF SERVICE – SURGERY CENTERS & HOSPITALS
You need to determine if you, as the patient, would pay less by going to an ambulatory surgery center with a lower price or by going to a not-for-profit hospital with a higher price and a financial aid policy that will ultimately result in a lower cost to you. About 60% of the community hospitals in the United States are not-for-profit organizations with charitable mission statements to provide care “regardless of patient’s ability to pay”.
It my opinion that most insurance companies do a pretty poor job of informing their high-deductible enrollees of how to identify the lowest cost providers. There may be a dozen or more facilities in your area that perform carpal tunnel surgery and accept your insurance. However, Cigna is the only major insurer that provides enrollees with a comparison tool so they can compare the prices among all these providers in a meaningful way.
5) PRICE SHOPPING CARPAL TUNNEL SURGERY COSTS
The patient portion of carpal tunnel surgery costs can vary widely among in-network physicians and facilities even within the same health insurance plan. If you have a high-deductible or if you are a self-pay patient, then you want to seek out the cheapest in-network provider because the first $2,000-$5,000 of any services rendered is your out-of-pocket cost and your responsibility to pay.
On the cheap end, some commercial insurance companies have negotiated carpal tunnel pricing at ambulatory surgery centers as low as $698 for the facility fee. ASC carpal tunnel surgery costs max out around $1,662.
On the expensive end, facility fees for some outpatient hospital departments average around $2,057 for carpal tunnel surgery and I’ve seen cases paid as much as $5,598 by some insurance companies on the east coast. This is because hospitals need insurance companies to pay them more than other providers to compensate for the cost of all the homeless and indigent patients they see for free. Don’t let anyone fool you into thinking carpal tunnel surgery is an expensive procedure to perform. The average material costs for carpal tunnel surgery are only about $120 in supplies and it only takes 30-35 minutes to perform.
You should also shop for the lowest physician’s fee for the procedure as well. Patients have to pay the physician and a facility separate fees for the professional component of carpal tunnel surgery.
Patients will also have to pay a small amount to the anesthesiologist for either a “bier block” or general anesthesia. Overall, bier blocks are cheaper because they essentially numb your arm and you stay awake for the surgery. If this freaks you out, you may elect to have general anesthesia and get totally knocked out for the surgery. Bier blocks are cheaper, but it is purely patient preference.
All-in here is the range of carpal tunnel surgery costs for one wrist:
|ASC Carpal Tunnel Surgery Costs||$698||$1,136||$1,662|
|Hospital Carpal Tunnel Surgery Costs||$1,198||$2,057||$5,598|
|Physician Carpal Tunnel Surgery Costs||$399||$746||$1,196|
|Anesthesia Carpal Tunnel Surgery Costs||$408||$408||$408|
|Total ASC Carpal Tunnel Surgery Costs||$1,505||$2,290||$3,266|
|Total Hospital Carpal Tunnel Surgery Costs||$2,005||$3,211||$7,202|
|Likely Savings in ASC*||$497||$276||$1,781|
6) APPLY FOR FINANCIAL ASSISTANCE WITH THE HOSPITAL
If you can apply for financial assistance before your surgery even happens, you can give yourself a really good headstart. The application is usually one to three pages long. You may have to attach your last two pay stubs or your tax return for last year. The application is the hospital’s tool for assessing your ability to pay your bill.
I advocate for completing this before the surgery whenever possible. The sooner they apply charity care, hardship discounts, and waivers, the sooner you can lock in a payment plan with the new balance.