With health insurance premiums reaching an all-time high, many patients are choosing to self-fund their medical care. Self-funding your surgery can often be more economical than paying high insurance premiums. In order to avoid paying too much, you need to be well informed and ask the right questions. Even if you are happy to pay a premium to see a highly recommended surgeon, you do not want to find out you paid twice as much as the average patient.
We first need to understand who you are paying for cataract surgery. There are three separate entities:
- Surgeon
- Hospital
- Anaesthetist
So where do we start?
Finding out the Surgeon fee:
My first piece of advice is to call or email the clinic or surgeons office and ask “How much is cataract surgery with Dr X?”. A common response you may encounter is:
“The cost varies based on several factors; it would be best to book an appointment to discuss your individual circumstance?”
This is the least satisfying response and essentially gives you no information. So now you are thinking “why am I reading Dr Ryan’s blog???”, “Thanks Dr Ryan…. Just call the clinic… ground breaking advice…”. If you do find yourself in this scenario, then follow the below script:
I understand there are different circumstances that can affect the price of surgery. To better help me, would you be able to give me information about what the surgeon fee using the item number 42702?
Example 1. Surgeon Fee
42702 is the medicare item number for cataract surgery. A surgeon will charge an amount to the patient and a medicare rebate of $627.90 will be refunded to the patient.
Dr X charges $1750 surgeon fee to perform cataract surgery. The medicare rebate is $627.90 which results in an out of pocket amount of $1122.10.
Next is the Hospital Fee:
Not all hospitals charge the same amount and often this can be the biggest factor which differentiates overall cost of cataract surgery. If you simply ask, “where does Dr X operate and what does the hospital charge for cataract surgery?”, you will likely not get a price. The likely response will be “it depends on the lens used for surgery”. If you would like to know the base price the hospital charges, then ask, “What is the price for cataract surgery using a monofocal lens”. This is the most common lens used during cataract surgery and results in high quality vision. If you need correction of astigmatism (type of glasses prescription error) or you would like a multifocal lens, this will often add between $400 – $1000 to the quote.
Example 2. Hospital Fee
Dr X operates at “Insert name” Hospital which charge $1850 for cataract surgery with a monofocal lens. There is no medicare rebate attached to this price. This is a facility fee including the cost of the lens.
If we assume the Anaesthetist fee is $500 out of pocket then we now know the price of cataract surgery.
- Surgeon fee = $1122.10 out of pocket
- Hospital fee including cost of lens = $1850
- Anaesthetist fee = $500 out of pocket
The total cost of cataract surgery is $3472.10 with a monofocal lens.
The prices above are for illustrative purposes only. If you do find yourself in the scenario of facing a significant bill for cataract surgery, then reach out to Dr Ryan via the website for up-to-date costs.
