Comparison of cataract surgery out-of-pocket cost with same insurance (hospital vs. ASC)
June 29, 2022
I came across this case of a married couple, Danilo and Marilou Manimtim, who both had cataract surgeries within the span of 4 months.
Danilo, a 73-year-old retired orthopedic surgeon in Fresno, Calif, decided to have his cataract surgery performed at Saint Agnes Medical Center in Fresno, CA.
Marilou, age 66, chose an outpatient eye care surgical center in Fresno called EYE-Q for her cataract surgery. EYE-Q is a half-mile from Saint Agnes Medical Center but is not affiliated with the hospital.
Danilo and Marilou have the SAME insurance coverage through Anthem Blue Cross of California.
Final Out-of-Pocket Cost
Overall, the charges were $9,084 for surgery, anesthesia, medical supplies, pharmacy, and clinical laboratory services. Anthem paid $5,027 and billed Danilo $4,057.
Her final out-of-pocket cost was $204, approximately 5% the amount her husband paid for the same cataract surgery.
Assuming quality to be the same among both providers and ubiquitous consumer-friendly price transparency, Danilo would have saved close to $4,000 by choosing EYE-Q over Saint Agnes.
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