Having insurance does not always mean insurance is the cheaper way to pay for surgery. If you are on a high-deductible health plan and have not met your deductible this year, there is a good chance a flat cash price costs you less out of pocket.
This post walks through the math using hernia repair, the most common surgery we do for cash and self-pay patients at DRP Surgery in Arlington.
How a deductible actually works
Your deductible is the amount you pay yourself each year before your insurance starts sharing costs. If your deductible is $7,500 and you have not had any big medical bills yet this year, you pay the first $7,500 of covered care yourself. After that, you usually still owe coinsurance until you hit your out-of-pocket maximum.
So when surgery is billed through insurance early in the plan year, a large part of the bill, often all of it up to the deductible, lands on you anyway.
A simple comparison
Here is a typical example for an inguinal (groin) hernia repair:
- Through insurance, deductible not met: the surgeon, facility, anesthesia and pathology each bill your plan at their negotiated rates. You pay those amounts until your $7,500 deductible is met, then coinsurance after that. The total is hard to know in advance.
- Cash at DRP Surgery: $3,900, one price, covering surgeon, facility, anesthesia and pathology. Known before you schedule.
If the insurance route would cost you more than $3,900 before your plan kicks in, paying cash is the better deal. If you have already met most of your deductible this year, insurance may come out ahead. The point is to compare before you schedule, not after the bills arrive.
Questions to ask before you decide
- How much of my deductible have I already met this year?
- What is my out-of-pocket maximum?
- Is the surgeon, the facility and the anesthesia group all in my network?
- Will I get separate bills for anesthesia and pathology?
- Does my plan year reset soon? (Waiting until January can reset your deductible to zero met.)
Our front desk can help you think through your own numbers.
Which procedures have flat cash prices?
Dr. P offers all-in cash pricing on 16 procedures, including:
- Inguinal hernia repair: $3,900 (reducible) or $4,000 (incarcerated)
- Umbilical and laparoscopic ventral hernia repair: $3,900 small, $6,200 large
- Colonoscopy for colon cancer screening: $1,275
- Laparoscopic gallbladder surgery: $5,850
- Hemorrhoidectomy: $3,700, or in-office hemorrhoid banding for $350
- Laparoscopic appendectomy: $5,700
- Breast biopsy and lumpectomy: $3,800
Every price includes the surgeon, facility, anesthesia and pathology. The initial consultation and evaluation is $200.
Why people choose cash even with insurance
- One number. No surprise bills from groups you never met.
- Faster scheduling. No waiting on prior authorization.
- Same surgeon start to finish. Dr. Rajesh S. Padmanabhan, MD, FACS, a board-certified general surgeon, does your consultation and your surgery.
Ready to get it fixed? Call (817) 466-7400 to book a $200 consultation, or text Dr. P your questions at (618) 406-6869. Office: 3215 Omega Dr, Arlington, TX 76014.
