How to Get a Cost Estimate for Knee Replacement Before Surgery

The hospital must list every expected charge tied to your knee replacement. This includes the facility fee, the procedure code (usually CPT 27447 for total knee replacement), and the surgeon's fee.

You'll also see charges from co-providers who bill separately. The anesthesiologist always appears on this list. So does the surgical assistant if one participates. Physical therapy charges show up if they're part of the immediate post-op plan.

The estimate includes specific dollar amounts for each line item, not ranges. Based on price transparency data published by Tampa area hospitals, negotiated rates for knee replacement vary wildly. BayCare's contracts show $12,915 with Blue Cross Blue Shield but $14,853 with Aetna. HCA Florida charges Blue Cross $9,962 but bills Aetna $29,886 for the identical procedure.

Your request needs five things: your full name, your date of birth, the specific procedure name (total knee replacement or knee arthroplasty), your scheduled surgery date if you have one, and a sentence requesting a Good Faith Estimate under the No Surprises Act.

You send it to the hospital's billing department, not your surgeon's office. The hospital coordinates with all the other providers who will bill you. If you don't know the billing department's contact information, the main hospital number can direct you.

No legal language required. The billing department knows exactly what a Good Faith Estimate means and knows the 3-business-day deadline applies. Hospitals face $300 fines per violation for missing that deadline.

Check that the procedure code matches what your surgeon ordered. CPT 27447 is a total knee replacement. If you see a different code, call the billing department before your surgery date.

Look for the anesthesiologist's charges on a separate line. If anesthesia charges don't appear, the hospital left out a required co-provider. Call and ask for a complete estimate that includes all separately billing providers.

Add up all the line items to get your total expected cost. If you have insurance, compare this total to your deductible and out-of-pocket maximum. If you're paying cash, this number is your negotiating starting point.

Three business days means three business days. If you sent your request on Monday, you should have the estimate by Thursday. If you don't, call the billing department directly.

If a week passes with no response, file a complaint with CMS. The online portal takes about 10 minutes. CMS investigates every Good Faith Estimate complaint because the fines are automatic and hospitals know it.

You can find the CMS complaint portal by searching "No Surprises Act complaint" or going directly to the CMS website. You'll need your request date and the hospital's name.

This is the billing trap that catches people on knee replacement. The anesthesiologist is frequently out-of-network even when your hospital and surgeon are in-network.

Your Good Faith Estimate will list the anesthesia provider's name or group practice. Call your insurance company with that exact name and ask if they're in your network. Do this before your surgery date, not after.

If the anesthesiologist is out-of-network, ask the hospital to assign an in-network anesthesiologist to your case. Most hospitals can accommodate this request if you ask at least a week before surgery. If you're paying cash, negotiate the anesthesia fee separately from the hospital's facility fee.