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 |  | With Health Insurance: Copay + 10%-50% Coinsurance |  | Without Health Insurance: $50-$15,000 |
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The rotator cuff, a group of muscles and tendons in the shoulder, can become damaged or irritated through normal wear and tear, following an accident, or as the result of repetitive arm motions, such as swinging a tennis racket. According to the Mayo Clinic[1] , rotator cuff injuries will heal with self-care measures or exercise therapy about half the time. However, some cases may require medical interventions, such as steroid injections or surgery.
Typical costs: | - Over-the-counter aids to treat mild rotator cuff injuries typically cost $2-$25. For example, theAce Instant Cold Compress costs $2.79. Other remedies, including non-steroidal anti-inflammatory drugs such as ibuprofen can cost about $5-$25, depending on the quantity and whether the patient buys a name brand or its generic equivalent.
- Patients seeking medical attention for injuries often start by seeing a general practitioner, which is typically covered by health insurance. For insured patients, out-of-pocket costs for a doctor's visit typically consist of a copay of $10 -$50 or more, or coinsurance of 10-50% or more.
- For uninsured patients, an office visit typically costs $50-$200 or more. The Medical Expenditure Panel Survey[2] , a set of large-scale surveys on the use and cost of health services conducted by the Agency for Healthcare Research and Quality, lists the average price of an office visit for an uninsured patient as $199.
- According to Blue Cross Blue Shield[3] the cost of treatments for an injured rotator cuff can vary from approximately $300 to $15,000 for hospital costs, plus $225 to $ 4,750 for physician costs. A study[4] published in the Journal of Shoulder and Elbow Surgery Board of Trustees in 2010 found that average surgical costs for patients who received a mini-open surgery was $7,841; patients who received arthroscopy paid $8,985 on average.
- Surgery typically is covered by health insurance. For insured patients, out-of-pocket costs typically consist of a specialist copay, possibly a hospital copay of $100 or more, and coinsurance of 10%-50% for the procedure, which could reach the yearly out-of-pocket maximum. According to the Kaiser Family Foundation[5] , the average hospital copay for outpatient surgery is $132 and for inpatient surgery is $232.The average coinsurance rate is 17%-18%.
Related articles: Physical Therapy, Shoulder Replacement, Health Insurance
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What should be included: | - The Mayo Clinic[6] recommends seeing a primary care physician when shoulder pain is severe or lasts more than a week, or if the injury brings a major loss of function or feeling. A primary care physician may ask questions and do a physical exam to get a sense of the severity of the problem. He or she may also recommend diagnostic imaging tests, such as an MRI or use a corticosteroid injection to curb inflammation.
- A doctor may recommend surgery if pain from a rotator cuff injury does not improve with nonsurgical methods, symptoms have lasted 6 to 12 months and are debilitating, or the tear was caused by acute injury.
- Many surgical procedures can be done on an outpatient basis, and typically involve reattaching the tendon to the upper arm bone, stitching the tendon together, or trimming and smoothing it. According to the American Academy of Orthopaedic Surgeons[7] three techniques are most commonly used for rotator cuff repair: traditional open surgery, in which the incision is several centimeters long, mini open surgery, in which the incision is about 3 to 5 cm long, and arthroscopic repair, a minimally invasive technique.
Additional costs: | - Physical therapy following surgery can help to improve the shoulder's range of motion. For insured patients out-of-pocket costs typically consist of a copay of $10 -$75 per session or coinsurance of 10%-50% or more. For uninsured patients it typically costs $50 -$350 or more per session.
Discounts: | - Many hospitals offer discounts of 30% of more to uninsured/cash-paying patients. At St. Joseph Hospital[8] in Orange, CA, for example, patients without health insurance may qualify for a 45% discount off billed charges. They'll also be offered an additional 10% discount if payment is made within 10 days of receiving a bill.
Shopping for rotator cuff treatment: | - The American Academy of Orthopaedic Surgeons features an orthopedic surgeon finder[9] .
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Material on this page is for informational purposes only and should not be construed as medical advice. Always consult your physician or pharmacist regarding medications or medical procedures.
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What People Are Paying - Recent Comments |
| Posted by: fred disbrow in New Bern, NC. | Posted: April 15th, 2016 10:04AM |
| Insurance Carrier: medicare | Inpatient or Outpatient: out |
Would somebody justify why people with insurance that pays 80% of a bill are tormented over 20% balance while medicaid patents have no premium zip for copays and the$2 for medicine what kind of a country is this? |
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External Resources: | - www.mayoclinic.com/health/rotator-cuff-injury/DS00192
- meps.ahrq.gov/mepsweb/data_files/publications/st318/stat318.shtml
- www.bcbst.com/learn/treatment-options/surgicaltreatment_rotatorcufftear.shtm
- www.ncbi.nlm.nih.gov/pubmed/20137974
- kff.org/health-costs/report/employer-health-benefits-2012-annual-survey/
- www.mayoclinic.com/health/rotator-cuff-injury/DS00192/DSECTION=symptoms
- orthoinfo.aaos.org/topic.cfm?topic=a00406
- www.sjo.org/For-Patients/Your-Hospital-Bill/Self-Pay-Discount-Program.aspx
- www7.aaos.org/member/directory/directory.aspx
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