Most people think of the anesthesiologist as the person who puts them to sleep before surgery and wakes them up when it’s over. That’s true, but they actually do much more. During and after your surgery, the anesthesiologist makes sure you are comfortable, that your breathing, heart rate and blood pressure are steady, and that you aren’t feeling any pain.
If you’re going to have surgery, or another procedure that requires anesthesia, it’s important to understand how these services work. That’s because they are often billed and paid separately, and are administered by specific providers who may not be affiliated with your hospital or your doctor’s practice. For example, even if you have surgery at an in-network hospital, the anesthesiologist still may not be part of your plan’s network.
Make sure you find out beforehand:
· Whether the anesthesiologist who will
provide your care is in your plan’s network
· How much she or he will charge; and
· How much your plan will cover.
That way, you’ll have an idea of how much you can expect to pay.
What Services Will I Need?
Anesthesia is usually used to block pain, relax you, or control your level of consciousness during surgery or other complex medical procedures. You may need anesthesia even if you’re not in the operating room. An anesthesiologist might treat you for pain management for an acute illness, a chronic condition like cancer, during childbirth or for outpatient tests like endoscopies.
There are two main types of anesthesia:
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Who Provides Anesthesia Services?
Anesthesia professionals make sure that patients receive anesthesia safely. This includes evaluating you before surgery, consulting with the surgical team, creating a tailored anesthesia plan, managing the patient’s breathing and other life support functions during surgery, and controlling pain. Usually, anesthesiologists are also the first to diagnose and treat medical problems during the recovery period after surgery. Anesthesia professionals may provide services at hospitals, ambulatory surgical centers, in an office or clinic, and other settings.
Anesthesia is often administered by an anesthesiologist, but may also be given by a certified registered nurse anesthetist (CRNA) or anesthesiologist assistant (AA). The differences are:
How Are Charges Calculated?
The cost of anesthesia is based on several factors: the difficulty of the procedure, the time it took, and “modifying factors” like the patient’s health. The formula for calculating anesthesia charges also includes a dollar value that depends on where you have the service.
The formula that is generally used to calculate an anesthesia charge is:
(Base units + Time units + Modifying units) x Conversion factor = Anesthesia charge
Let’s see how each of these factors works:
Anesthesia Base Units
Each anesthesia procedure has a “base unit” value. The base unit reflects how hard the procedure is to perform, and how much skill it takes. The more difficult it is, the higher the number of base units. The number of base units for each anesthetic procedure is fixed, and does not change.
The anesthesia charge also includes the amount of time that it took to provide the anesthesia. These “time units” are usually 15 minutes long. For example, if anesthesia is provided for 45 minutes, 3 time units will be included in the formula for calculating the anesthesia charge
(45 ÷15 = 3).
The “modifying unit” accounts for special conditions that may affect the anesthesia. This could include the patient’s health – for instance, if the patient has cancer – or if the anesthesia was provided in an emergency.
Conversion factors are dollar amounts assigned to specific geographic areas. For instance, the conversion factor in Buffalo, New York may be different from the factor for Raleigh, North Carolina. This accounts for the difference in the cost of providing care in different areas.
Total Anesthesia Charge
The total number of units (base units, time units, and modifying units) is multiplied by the conversion factor to calculate the charge.
Here’s an example:
A relatively healthy patient (no modifying units apply) received anesthesia for gallbladder surgery, which is valued at 7 base units, for 75 minutes (5 time units). The patient was in a location with a conversion factor of $70. The anesthesia charge will be:
(Base units + time units + modifying units) x Conversion factor = Anesthesia charge
(7 base units + 5 time units + 0 modifying units) x $70 = $840 charge
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Your Action Plan: Know Before You Go
There are times when receiving anesthesia services outside your network is simply unavoidable. But, when you can plan in advance, make your choice an informed one. Follow these tips to help manage your out-of-pocket costs:
And most importantly – if you’re not sure, ask! You are your best advocate. Speaking up and asking questions up front may help you avoid unexpected bills and plan appropriately for your medical expenses.
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