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Navigating the Maze of Surgery Costs: Strategies to Save Money on Your Medical Care

March 18, 2024

Navigating the Maze of Surgery Costs: Strategies to Save Money on Your Medical Care

Patients may find undergoing surgery to be a source of anxiety and fear. The psychological, spiritual, and physical obstacles are formidable enough without the added weight of prohibitively expensive medical expenses.

As per studies, around 37% of the Indian population is covered by PM-JAY or Aayushman Bharat Scheme, a National Health Protection Scheme established by the Indian Government, employment-based insurance, regional schemes, and voluntary for-profit insurance, among others. 

Despite the access to many facilities, many patients continue to have difficulty covering their portion of surgical costs. The excellent news is that there are strategies to lower surgical costs. You can reduce the amount of money you spend on medical care and gain some insight into the subject through proactive planning. 

Breakdown of Medical Surgery Bill 

Surgical procedures in India can be quite pricey if one lacks knowledge of the intricate components that comprise the overall cost of care. The following factors significantly impact the cost of surgery in India:

  • Surgeon's Fees - This includes the consultation and surgical fees of your operating physician. Fees are typically determined by the surgeon's experience, specialization, and seniority.
  • OT Charges - OT charges encompass expenses related to the utilization of the operating room, surgical apparatus, monitors, and similar resources. 
  • Consumables - Everything used during surgery, including masks, syringes, medicines, and implant devices. These substantially contribute to the bill.
  • Room Rent - Your room type, whether twin sharing/private, and the number of days stayed at the hospital impacts overall billing. ICU stays incur higher expenses.
  • Investigations - The billing for preoperative and postoperative blood tests, pathology tests, and diagnostic imaging may be distinct.
  • Medicines and Supplies - Medications prescribed for you to take home or administered in the OT or ward increase your overall bill.

Different Strategies to Save Money on Healthcare Costs

Here are different strategies that you can utilize to save money on surgical costs

  • Compare Hospitals and Surgeons

Conduct exhaustive research and compare prices from at least three to four hospitals and skilled surgeons regarding the exact surgery that requires your attention. Prior to selecting a surgeon, take into account their credentials, area of expertise, incidence of complications, and track record of performing similar procedures.

In addition to surgery fees, consider the hospital's infrastructure, accreditations, ratings, and postoperative care facilities. 

Selecting the most cost-effective estimate from a recognized surgeon affiliated with a reputable medical facility, one whose services align most closely with your financial means and requirements, is prudent. 

Obtaining multiple quotes and opinions prior to making a decision increases your chances of finding the right surgeon. It is a strategic step to lower the overall medical bill. 

  • Ask about discounts

Many medical facilities offer financial discounts or discounted packages to patients who remit the complete estimated surgery cost in advance. As early payment of cash reduces administrative expenses and payment collection delays for hospitals, they offer discounts in recognition of this. 

Furthermore, it is advisable to contact the hospital to determine whether they offer any seasonal promotions, corporate deals, or priority projects that grant senior citizens, Aadhar card holders, and other discounted rates. 

For certain common surgeries, some healthcare providers also offer packaged pricing plans that include surgeon fees, OT charges, room rent, medications, and more in one lump sum. Choosing these facilitates the acquisition of a fixed, all-inclusive estimate of surgical costs in advance, as opposed to receiving separate invoices for different components, increasing the medical expenses.

  • Evaluate insurance coverage

Review your current health insurance policy in detail or obtain one that provides coverage for hospitalization, recovery costs, and planned surgical procedures. It is one of the important factors to lower the medical bills. Verify the specifics of exclusions, waiting periods, co-payments, inclusions, and pre-existing health condition-related exclusions. This will clarify the proportion of your hospital and surgical expenses that will be covered by insurance versus your future out-of-pocket expenses. 

Additionally, having insurance qualifies you for decreased CGHS-approved charges for surgical procedures, as opposed to much higher retail rates. Additionally, verify whether the terms of your policy cover charges for OPDs, pre- and post-hospitalization expenses for 30-60 days, intensive care unit (ICU) charges, and advanced treatment methods. You are permitted to port to an appropriate high-coverage plan from another insurer if your current policy has a deficiency.

  • Use financial assistance programs.

If you are unable to afford surgery due to financial constraints, explore available financial assistance programs to manage the medical expenses. Deserving economically weak patients can obtain financing for life-saving surgeries through sponsorship programs, income-based fee waivers, or loans from several large charitable hospitals, NGOs, and government agencies. 

In Maharashtra, state government projects such as the Rajiv Gandhi Jeevandayi Arogya Yojana provide financial assistance for surgical procedures amounting to 2 lakhs. The Rashtriya Arogya Nidhi and other projects of the Central Government Health Ministry provide financial help of up to 15 lakh rupees for surgical procedures for the impoverished. Patients below or just about the poverty line can apply through social organizations working in hospitals after submitting income proofs, BPL ration cards, and required documents as per eligibility criteria norms. 

  • Ask for hidden costs upfront.

Thoroughly examine and analyze the complete detailed account line by line before hospital discharge to identify any redundant utilization of surgical consumables, medications, or unjustified overcharging. Inquire with the billing team about any expenditure head, consumable consumption, uncovered diagnostic tests, non-transparent charges, or anything else that appears exaggerated, strange, or confusing to you. 

A thorough clarification prevents one from being taken advantage of by unanticipated concealed costs that are subsequently disclosed. During admission, you may negotiate or refuse payment for items you did not consent to. One may request installment options if substantial payments are difficult to remit.

Can Health Insurance Help Cover Surgery Bills?

Having health insurance can be a tremendous asset when you or a member of your family requires surgical treatment. This is how it reduces the cost of costly operations in India:

  • Cashless hospitalization

Numerous policies provide cashless hospitalization, in which the insurance company and the facility resolve medical expenses directly. This prevents you from having to pay substantial upfront out-of-pocket costs for surgery.

  • Coverage for OT charges, medicines, tests

During hospitalization, policies provide coverage for anesthesia, medical consumables, diagnostics, medications, operation room expenses, and physician fees. This settles the majority of the tab.

  • Pre and post-hospitalization cover

Doctor-recommended expenses incurred a few months before admission and following discharge are covered up to certain limits. Also provided is financial assistance during the recovery period.

  • Sub-limits for specific procedures

Subsequent to the sublimity or upper claim amount restrictions that apply to specialized surgeries such as neurosurgery, bariatric surgery, joint replacement, and so forth, you are responsible for payment.

  • Room Rent Capping

ICU and private ward room rent eligibility is capped daily by insurance companies. The subsidy for luxury or amenity room rent is not applicable.

  • Co-payment Clause

With this clause in the insurance policy, the patient has to pay a fixed percentage of the total cost out of pocket; the insurer covers the remaining balance. This clause helps to keep the premium lower.

While health insurance greatly eases medical expense burdens, reviewing the above terms helps set the right expectations on outgoings. Exclusions and limitations are clarified in the policy document, allowing for hassle-free claims. 

Wrapping up,

Navigating the mazes of medical invoices and surgical expenses can be overwhelming. You can, nevertheless, acquire quality care and exert greater control over expenses with the aid of accurate information and astute preparation. Leveraging its scope, Apollo Spectra provides specialized surgeries at reasonable costs with personalized service in twelve Indian cities and by a staff of 2,300 expert physicians. 

Consider Apollo Spectra for your surgical requirements, given our dedication to setting higher healthcare standards and more than 250,000 successful surgeries. For optimal health outcomes, the seasoned staff can assist you in making well-informed financial decisions regarding surgery expenses throughout your treatment journey.

What is my out-of-pocket cost estimate before surgery?

Request an itemized quote from the hospital ahead of your procedure that clearly details surgeon fees, OT charges, room rent, meds, etc. Also, check with your insurer on policy coverage limits, co-pays, or sub-limits applicable to get clarity on your share of surgery expenses.

What documents do I need to apply for financial assistance programs for surgery?

You would need to provide identity proof, residence proof, income statements, bank statements, and applicable medical reports to establish your eligibility as economically weak to apply for government or NGO-run financial assistance programs for subsidized surgery.

My health insurance policy excludes pre-existing conditions. How do I still get coverage for surgery?

Cross-check if your specific planned surgery is directly related to the excluded condition. If not, file a fresh proposal form disclosing your complete history and wait out the 2-4 year waiting period for pre-existing diseases set by the insurance company before claiming surgery expenses against policy later.

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