Shoulder Replacement Cost

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.

• 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.

• 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.

• The American Academy of Orthopaedic Surgeons features an orthopedic surgeon finder^[9] .

1.  orthoinfo.aaos.org/topic.cfm?topic=A00094
2.  www.ncbi.nlm.nih.gov/pubmed/16980898
3.  www.zimmer.com/web/enUS/pdf/Shoulder_Coding_Guide_7-21-11.pdf
4.  kff.org/health-costs/report/employer-health-benefits-2012-annual-survey/
5.  my.clevelandclinic.org/services/shoulder_replacement/hic_total_shoulder_joint_repl...
6.  my.clevelandclinic.org/services/shoulder_replacement/hic_total_shoulder_joint_repl...
7.  orthoinfo.aaos.org/topic.cfm?topic=A00504
8.  www.sjo.org/For-Patients/Your-Hospital-Bill/Self-Pay-Discount-Program.aspx
9.  www7.aaos.org/member/directory/directory.aspx

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