Breaking Down Your Surgery Quote: Understanding Fees and Costs

Preparing for surgery can feel overwhelming, especially when it comes to considering the financial aspects. This guide is here to simplify the terminology and information you might see on your surgeon's quote, so you can feel informed and confident as you plan for your procedure.

What are surgeon’s fees? 

Surgeon’s fees are the costs that are paid directly to the surgeon performing your surgery and cover their time and expertise in performing the surgery.

These fees may also include any medical devices or products intended to be left in your body as part of the surgery, such as implants. Sometimes the cost of these implants are listed out separately alongside a line item that specifically says “Surgeon’s Fees,” but typically they are included in the “Surgeon’s Fees” umbrella and not listed out separately. 

These fees are typically paid directly to the surgeon that is performing the procedure. 

What are facility fees? 

Facility fees are the costs paid to the hospital or surgery center where your procedure takes place and typically cover the time using the facility, as well as the support staff and administration that help your surgeon perform the procedure. Facility fees also typically cover the use of any equipment used during your surgery that are not left inside your body as part of the procedure, such as dressings and scalpels. These fees are also sometimes referred to as hospital fees or operating room (OR) fees. 

• If your surgeon is performing the procedure in a facility that they own, these fees may be due directly to the surgeon performing the procedure at the same time that you pay the surgeon’s fees.
• If your procedure is being performed in a facility that they do not own, like a third party surgery center or a hospital, the fees are likely due directly to the facility. 

The surgeon’s quote will typically address where this payment is due and, if not, it’s always recommended that you reach out to your surgeon's office for advice on where to make these payments. 

What are anesthesia fees? 

Anesthesia fees are the costs associated with putting you under sedation for your procedure and cover the medications associated with your anesthesia, as well as the time and expertise of the anesthesiologist that is monitoring you during your procedure. 

• These fees are often paid to the facility where your procedure is performed alongside the facility fees, but some facilities contract a third party to perform their anesthesia services. In those instances, you may need to pay the anesthesia provider separately. The surgeon's quote usually specifies where payments should be made. If it doesn’t, it's a good idea to contact your surgeon's office for guidance on the payment process.
• If you have insurance, your insurer may cover some of the facility and anesthesia fees, even in situations where your surgeon’s fee is not covered. Most facilities have a medical billing specialist and a patient care coordinator (sometimes called a navigator) that can help you determine what, if any, part of your facility fees your insurance will cover.
• If you have complications or your procedure takes longer than originally expected, the facility and anesthesia fees may change. If this happens, you will likely receive a bill from the facility and/or anesthesia provider after the procedure. If you have questions about any bill that you receive, it’s recommended that you reach out to the billing department to inquire about the additional charges. 

What other fees could I see on my quote? 

Here are a few examples of additional fees you might see on your quote and what each typically covers.

• CosmetAssure: Some providers, especially for more complex procedures, use a service called CosmetAssure that helps offset some of the costs associated with complications of your procedure.
• Enhanced Warranties: Most implants come with some variety of warranty against defects. Some manufacturers offer extended or enhanced warranties on their products and, if you select these warranties, the cost is often reflected in your quote.
• Pathology: Pathology fees are frequently associated with procedures, like FtM/N top surgeries, hysterectomies, or orchiectomies where tissue is removed from the body. These tissues are typically sent to a lab for evaluation for abnormalities, whether or not there are other risk factors associated with the tissue. These fees are rarely collected up front, but are often noted on your quote to make you aware of them. Your surgeon can give you more information about what sorts of pathology fees to expect. As with the facility and anesthesia fees, your insurer may cover some of the pathology fees, even in situations where the rest of your procedure is not covered. When you receive your pathology fees, it’s recommended that you reach out to the laboratory billing department to see if they can bill your insurance for the costs.
• Inventory or Product Fees: Product fees are the costs associated with additional materials that are used for your procedure, such as implants, specialized instruments or scar care products. These are sometimes included in your surgery fees, but sometimes are listed out separately, especially if you are using premium products or receiving some sort of advanced care. 

Understanding the fine print on your quote

Your quote will also likely contain information about how to process payments, who the payments are due to and when the payments are due. 

Deposits are typically due to your surgeon’s office to secure your surgery date. Deposits are usually a portion of your total quote and count toward your final balance. For lower-cost surgeries, the deposit may be a flat amount rather than a percentage of your quote.

Many deadlines on the remaining balances are based on your surgery date, so your provider’s surgical coordinator will communicate the exact deadlines more explicitly once you’ve booked a surgery date. 

Paying your balance

It’s common to see phrasing like “Your procedure MUST BE PAID IN FULL THREE WEEKS BEFORE your date of surgery.” Once you’ve booked a surgery date, it’s important to ask your surgeon for clear communication about all future deadlines, especially if your balance is due on a holiday or when the office will not be open. 

When considering the timeline for paying off your balance, it’s important to consider any limitations that your bank or credit card may have on spending, like daily spending limits or credit limits.

• Depending on your situation, you may need to split the payments across multiple days or payment methods, so be sure to leave yourself enough time to take care of the full balance ahead of your due date.
• When making these plans, be sure to remember that facility and anesthesia fees may be due separately and you’ll need to factor those payments into your timeline.
• It might also help to reach out to your bank or credit card to warn them about larger transactions so they don’t lock your account for fraud and derail your timeline. 

If paying by check or money order, be sure to factor in time that the check will be in the mail and consider using a mailing service that includes tracking so that you know when it has arrived at the surgeon’s office. Before mailing your check, be sure to get the exact address that you need to mail it to and ensure that your check includes all information the surgeon or facility will need to associate it with your account, like a Medical Record Number (MRN) or account number. 

What’s the difference between an estimate, a quote, and an invoice?

An estimate and quote are the same thing, and can be used interchangeably to refer to the document that your surgeon will give you to approximate the costs of your surgery. Quotes have an expiration date and are typically locked in once you pay the deposit to your surgeon and book your surgery date, with the exception of the facility and anesthesia fees noted above. If your procedure is not booked by the expiration date listed on your quote, your surgeon may not be able to honor the quote and costs may change. A quote does not mean that you owe anyone any money unless you choose to move forward with the services listed on the quote. 

An invoice, sometimes called a bill, is a statement of money due and reflects the costs of services that have been performed or are expected to be performed on your surgery date. Most surgeons will not issue a separate bill or invoice for your procedure and expect the quote to be paid in full before your procedure is performed. It’s also rare for your facility and/or anesthesia provider to issue an official invoice for your procedure. 

Why did I receive a bill after surgery? 

You will commonly receive a bill or invoice after your procedure if there are facility and/or anesthesia overages and for the pathology fees associated with your procedure. Your facility may also bill you for any unexpected medications that you used during your time in the facility.

If you ever receive an unexpected bill, it’s recommended that you reach out to the billing department that sent the bill. If you’re unsure about the charges, you can also ask the billing department to send over an itemized bill so that you can review the charges for anything you’ve already paid. 

Other costs to consider

Consultations

Most surgeons charge a consultation fee. This fee varies based on the surgeon, but is typically under $1,000.00. A consultation fee covers the time for the surgeon to examine your body, discuss your goals with you, and generate a surgical plan and quote. Many, but not all, surgeons will put the cost of the consultation toward your final surgical expenses if you choose to book your procedure with them. 

Pre-operative clearances

The amount of pre-operative clearance you’ll require will depend on your surgeon, the procedure you're planning to have, and any preexisting conditions that you may have or be at risk for. Most surgeons will require, at minimum, some preoperative blood work to evaluate your general health and screen for risk factors. It’s also relatively common to be required to complete a COVID-19 screening prior to your procedure. 

Other common clearances include, but are not limited to: 

• An EKG if you have a history of heart conditions
• A CT scan or X-Rays before procedures where bones may be shaved, adjusted or enhanced (such as Facial Feminization Surgeries)
• A mammogram if you’re considered high risk for breast cancers
• An ultrasound is commonly required before hysterectomies

Your preoperative clearances may also be covered by your insurance, so be sure to talk to the billing coordinator at the lab or imaging facility where your clearances take place. 

In conclusion...

Understanding the costs involved in surgery is key to keeping your timeline on track and reducing stress. Remember:

• Stay connected with your surgeon and their team: Don’t hesitate to ask questions about any fees or payment deadlines you’re unsure about.
• Check your insurance coverage: Know what your insurance will cover and any out-of-pocket costs.
• Explore payment plans or financing options: If needed, talk with your surgeon’s office or facility about these possibilities.

By preparing financially ahead of time, you can enter your surgery with peace of mind, ready to focus fully on your recovery rather than unexpected expenses.