TLDR: If you need outpatient surgery, it is usually cheaper to go to an in-network ambulatory surgical center than an in-network hospital.
Hi all, Bryanna here! This week I have a personal story to share - one (of many) that led to the creation of this blog. Three years ago, I felt some pain, so I went to an in-network Urgent Care ($40 copay) where I was told that I needed to have a cyst removed.
Much to the doctor’s surprise, I asked what CPT code the procedure would be billed under. After a blank stare she looked up the 5 digit CPT code, patched me up, and sent me on my merry way with a list of recommended surgeons who could perform the removal.
As you have probably figured out, nothing makes me happier than finding a good deal in the convoluted world of healthcare, so I went home and started researching.
First, I went down the list to find out which surgeons were in-network with my insurance, and realized only 4 out of 8 were! With that narrowed down list, I went online to research the doctors and find out where they performed their surgeries. All four surgeons were affiliated with three hospitals.
First thing Monday morning, I called the hospitals and asked to speak with the billing office. I asked them about their contracted rate (the amount the insurance company and the provider have agreed to pay/be paid for the service) for Blue Cross Blue Shield and the CPT code I was given by the Urgent Care.
I got the following answers:
Hospital A: $5,287
Hospital B: $3,980
Hospital C: would not provide an answer...this is never a good sign.
YIKES! This was just the facility fee! It didn’t even include the doctor's fee or the anesthesiologist's fee!
Here’s a big secret in healthcare: Hospitals are EXPENSIVE. Ambulatory surgical centers can be CHEAP.
Armed with this knowledge, I went through the following steps to narrow down surgeons. While this may seem like a lot of work upfront, in total it took me about two hours, and ended up saving me over $4,000. So, totally worth it!
I googled "ambulatory surgical centers in Dallas" and found a list which I compared to the in-network list on my insurance provider search (on the insurance provider’s website).
I found five ambulatory surgical centers that were in-network, and went to each of their websites and found their list of surgeons.
I then checked each general surgeon on the insurance network search, and crossed them off the list if they were not in-network.
Finally, I was left with a list of 7 in-network surgeons who performed surgery at 3 in-network ambulatory surgical centers.
I then called the surgeons to ask if they performed the specific surgery I needed, and to see if they had availability within the next few weeks. Of the 7 on the list, 3 of them did.
I then called the ambulatory surgical center for each of the three surgeons and was quoted the following contracted rate for the CPT code with BCBS:
ASC A: $2,140
ASC B: $3,454
ASC C: $1,293
DING DING DING - we found our winner!!!
I ended up scheduling a consultation and had the surgery with the doctor at ASC C. Afterwards I received a bill for exactly what was quoted to me - $1,293.
Total time researching: 2 hours
Total amount saved: $3,994
You can do this too! If you need to have an outpatient surgery, ask your surgeon if they can do it at an ambulatory surgical center, or (if you aren't attached to your surgeon) look for a different surgeon who goes to an in-network ambulatory surgical center.
Use this website to find accredited ambulatory surgical centers near you. Good luck and leave us a message in the comments below if you have any similar stories!