Shoulder replacement surgery is used to treat chronic shoulder pain and stiffness caused by degenerative joint disease, arthritis and other conditions. During the procedure, a metal ball and polyethylene cup is used to replace the head of the upper arm bone and its socket. According to the American Academy of Orthopaedic Surgeons[1] , shoulder replacement may be an option if non-operative treatments such as arthritis medications and physical therapy don't help.
Typical costs:
Shoulder replacement surgery typically costs $7,000-$21,000 or more, depending on the type of implants used and the hospital in which the procedure is performed. According to a 2007 study[2] by researchers from Johns Hopkins University, a shoulder replacement's total costs, on average, are $10,351. A more recent report [3] by Zimmer, a manufacturer of orthopedic prosthetics including those used in shoulder replacements, notes that in 2011 Medicare typically paid between $10,919 and $13,413 for total, partial and reverse shoulder replacements. In Vermont community hospitals, costs for this class of surgery ranged from about $7,000 to more than $21,000.
Shoulder replacement 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[4] , the average hospital copay is $132 for outpatient surgery and for $232 inpatient surgery. The average coinsurance rate is 17%-18%.
According to the Cleveland Clinic[5] , patients who are interested in shoulder replacement would have an initial appointment with an orthopedic surgeon. The visit may include a series of x-rays, a physical examination and a thorough review of the patient's medical history.
Shoulder replacement surgery[6] is an inpatient procedure. It is typically scheduled in advance, lasts about two hours, and brings an average hospital stay of one to three days. A series of pre-operative tests, including blood tests, an electrocardiogram and a physical exam will be scheduled a few weeks before surgery.
Depending on the damage to the cartilage, the surgeon may decide to replace only the ball of the joint. Patients who have severe arthritis, completely torn rotator cuffs, or had a previous shoulder replacement that failed, may also be advised to get a reverse total shoulder replacement[7] in which a metal ball is attached to the shoulder bone and a plastic socket to the upper arm bone.
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 shoulder replacement:
The American Academy of Orthopaedic Surgeons features an orthopedic surgeon finder[9] .
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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my daughter has been told she must have had 3 arthroscopys before receiving a shoulder replacement. Is this correct She is 46 and this would be the 5th surgery on her rt shoulder.
I have had many experiences with the comp people concerning my left shoulder. I would like to know the quick ans. if shoulder replacement is an offer. Cost of lowest amt and the highest amt.
My shoulder replacement was extremely expensive. Up to 150,000. With pt. But the ins. Co. Fought the cost every time a bill came out. So the bottom line is how much did the ins. Co. Pay the total cost???
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