Total knee replacement surgical procedures within the United States vary between $45,000 and $70,000. Research has revealed that the total cost typical for a knee replacement within the United States in 2020 is between $30,000 and $50,000. However, it could be confusing to find out exactly what that cost includes. The average knee replacement procedure price is $57,000, according to LendingPoint. Blue Cross Blue Shield estimated in 2019 that the average cost of an inpatient knee replacement procedure was $30,249 compared to $19,002 being an outpatient. In addition, 2013 article in AARP, U.S., the total knee replacement (TKR) hospital charge was $50,000.
Five key factors that affect the cost of knee replacement surgery
1.Your health insurance coverage
Your quality of life insurance plan will play a significant role in how much you pay for knee replacement. Therefore, we suggested taking time to understand your insurance coverage before starting the knee replacement process.
Your knee replacement shall be “ordered” by way of a physician to be covered by insurance. This order allows the insurance provider to know a knee replacement operation is essential in reducing or managing your knee pain and loss of function.
Your share of costs for such covered services will depend on your specific health insurance plan, and regardless it has copays, deductibles, or coinsurance. Expenses could also differ according to what other care costs you’ve already had to pay during the plan year.
More insurance coverage companies, like HealthPartners, address knee replacements. Medicare and Medicaid furthermore cover knee replacements.
- A scheduled appointment and initial evaluation with your orthopedic doctor.
- Some medical types of equipment like safety bars will help prepare your home for your recovery.
- The care you receive while you’re recovering immediately after your surgical procedure.
- Appointments you will need before the operation, such as an assessment that is suitable for diagnostic exams.
- The knee replacement surgical treatment includes the implant itself, anesthesia, and costs for the doctor and operating room.
- Physical therapy appointments you might need to help you recover.
2.Where you get your knee replacement surgery
Knee replacement surgeries can be carried out at both hospitals and operation facilities. An operation center is just a location that focuses on same-day surgeries and might or might not be attached to a medical center.
The fees for the operating room can have a meaningful impact on the final cost when you have your procedure at a medical center. In a few cases, expenses could be affected by just how long you will need to remain in a medical facility. But even as we mentioned previously, usually decided by just how your surgical procedures are categorized. All that said, usually, it’s less costly – for you and your insurance company – if you have your procedure at a surgery center.
3.The type of knee replacement you need
You will find three kinds of knee surgeries, each with varying degrees of equipment needs and complexity.
- Partial knee replacement
- Total knee replacement
- Revision (or complex) knee replacement
Your orthopedic doctor will decide which kind of knee replacement will perfect for you. Some orthopedic surgeons coach you through the procedure, make recommendations based on many factors, such as your age, knee health, range of motion, lifestyle, goals, bone structure, and the possibility of needing a revision surgery in the future.
A revision operation is, in fact, the absolute most costly. The total cost of any surgical procedure depends on the complexity of surgical treatment, including a partial knee replacement, typically spending anywhere from 10% to 50% lower than a total knee replacement.
4.Your knee replacement surgery ‘classification.’
There are two main kinds of knee replacement surgical procedure classifications: Inpatient surgeries and outpatient surgeries.
Often, “inpatient” means you’ll have a hospital. Stay after the operation, and “outpatient” means you’ll be discharged the same day as your surgery. But that may not be how your insurance company classifies your surgical procedures.
In reality, the knee replacement operation is likely categorized being an outpatient surgical treatment. Many patients go home the same day as their surgery if they meet specific criteria and their insurance covers it. But even though an individual spends a night in the medical center, it is most likely that their operation will be considered outpatient. This can have an impact on the total amount you’re responsible for.
5.Your recovery plan
Where you go to recover quickly after your surgery treatment can influence total costs. If you have your surgery at a hospital, the chances are that your insurance company has already made one or more late stays into a fixed-rate payment. This means that regardless of how long you stay, the insurance company pays the hospital one expense. This also means you don’t have to worry about acquiring additional costs if you need to stay a day or two in the hospital if your physicians suggest doing so.
But as previously mentioned, if you have your surgery at a surgery center, you’ll be discharged on the same day. That means you’ll head home to begin your recovery – unless you opt for transitional care.
In addition, whether you go home to recover or stay somewhere for a couple of days, physical therapy and rehab will be a big part of your knee replacement recovery process. Physical therapy does exercises and stretches to improve your knee function and mobility, and quality of life. How regularly you see your physical therapist and how long you need physical therapy are also cost factors.