Below is a list of health insurance plans that we accept. For additional questions and information please visit our billing company, Medac.
How are Anesthesia Services Measured and Billed?
The cost for anesthesia services is calculated based on several criteria: the difficulty of the anesthetic procedure, the time it took to administer the anesthesia, and other modifying factors (such as the health of the patient). The method for calculating anesthesia charges also includes a dollar value that is specific to a particular location.
The formula that is generally used to calculate an anesthesia charge is:
(Base units + Time units + Modifying units) x Conversion factor = Anesthesia charge
Anesthesia Base Units
Each anesthesia procedure code has a base unit value, which reflects the difficulty and the skill required to perform the procedure. The more difficult and anesthesia procedure is to perform, the higher the number of base units the procedure is assigned. The number of base units for each anesthetic procedure are constant and do not change.
In addition to the number of base units for an anesthetic procedure. the anesthesia charge also reflects the amount of time that it took to provide the anesthesia service. This is denoted by time units, which as typically 15 minutes in length, but may also be 10 or 12 minutes depending upon the location where the service is provided. For example, using a 15-mintes time unit, if anesthesia is provided for 45 minutes, 3 time units will be included in the formula for calculating the anesthesia charge. (45/15 = 3)
A third factor in the calculation of an anesthesia charge is the modifying unit. This takes into account special conditions that may affect the setting in which anesthesia is given, Modifying factors may include the patient’s physical status (a patient may be health, or may have other systemic diseases), or emergency situations.
Conversion factors are dollar amounts that have been assigned to each unit. These conversion factors are specific to the location of the healthcare provider. A conversion factor in Buffalo, New York may differ from the conversion factor for Raleigh, North Carolina.
Total Anesthesia Charge
The total number of units (base units, time units, and modifying units) is multiplied by the conversion factor.
Let’s see an example of how this might work:
A relatively healthy patient (no modifying units apply) received an anesthesia service for gallbladder surgery which is valued at 7 base units, for 75 minutes, and received care in a location that has been assigned a conversion factor of $70. The anesthesia charge will be calculated as follows:
(7 base units + 5 time units + 0 modifying units) x $70 = $840 total charge
How are Anesthesia Services Reimbursed?
Because anesthesia services are billed separately from other procedures and are administered by distinct healthcare professionals, you insurer may reimburse for anesthesia services separately. For example, even if you undergo surgery at an in-network hospital, the anesthesiologist may not be part of your plan’s network. It is important to know beforehand whether the anesthesiologist who will provide you care is in your plan’s network, and how much s/he will charge, so that you can know what to expect on your bill.
Your Action Plan: Know Before You Go
There are times when receiving anesthesia services outside your network is simply unavoidable. But, when you have the opportunity to plan in advanced, you choice should be an informed one. Follow these tips to help manage your out-of-pocket costs if you will be undergoing a procedure that requires the care of an anesthesiologist:
- Ask your provider to refer you in-netowrk first unless there is a specific reason why you want to go out-of-network.
- If you’re having surgery, ask if the professional who will administer the anesthesia participates in your plan’s network.
- If you choose to go out-of-network for a procedure that requires anesthesia, ask your provider how much you will be charged. Then, ask your insurer how much of the service your plan will cover.
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.