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Premera Blue Cross helps you connect with resources so you can make informed decisions about your health.
As you prepare for an upcoming surgery or procedure, you may have questions about the quality and cost of your care. We can help you understand your benefits and what affordable care options are available to you.
Download and print this list of questions to discuss with your provider.
Additional expert information about your diagnosis and treatment options may help. Learn more about second opinions.
Use Healthwise decision aids to help better understand your procedure.
Sign in and check your benefit details.
Find out more about preapproval for some services and procedures.
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Get help (at no extra cost) navigating healthcare from a licensed clinician, who can:
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While you have a variety of options with your plan’s network, out-of-pocket costs and quality can vary by facility and procedure type.
When a surgery requires you to stay one or more nights in a hospital, it’s referred to as an inpatient surgery. Inpatient surgery may be required for complex procedures that need an extended recovery period or close monitoring.There also may be certain health conditions that make it safer for you to be in a facility with larger medical resources.
Lung and heart surgeries or childbirth are generally inpatient procedures.
Inpatient care is often more expensive because of the amount of care involved. All hospitals have different costs and quality ratings.
Procedures that do not require you to stay overnight in a hospital or facility are called outpatient surgeries. Outpatient procedures allow you to go home the same day as your procedure. These procedures may also have faster recovery times due to improvements in anesthesia and less invasive surgical techniques.
Colonoscopies and ear, nose, throat, or orthopedic procedures are generally outpatient procedures.
Outpatient costs are almost always lower than inpatient costs. Some outpatient settings, like ambulatory surgical centers, report quality metrics equal to or better than other types of care facilities, like hospitals.
Hospitals and outpatient surgery centers offer different capabilities and specialties for different health needs. Talk to your provider about inpatient and outpatient care. They will review your health status, procedure type, and any possible complications to determine the best location for your procedure.
Ear, nose, and throat
Tonsil removal, ear tubes, cataracts
Stomach and colon
Colonoscopy (colon exam), endoscopy (digestive track exam), hemorrhoid removal
Biopsies (such as breast, bone, liver, or other); hernia repair; appendix removal; gall bladder removal
Hysteroscopy (uterus exam); hysterectomy (removal of the uterus); tubal ligation (cutting or removal of fallopian tubes)
Cataract removal, retina repair, cornea transplant
Bunion removal, hammer toe repair
Some prostate surgeries, bladder exam by scope, kidney stone surgery
Varicose veins
Knee repair, ACL repair, shoulder repair, hand or wrist procedures, treatment of fractures or dislocations, total joint replacements
This is not a full list of all procedures that can be performed in an outpatient setting. Always check your benefits to ensure your procedure is covered under your health plan.
Ambulatory surgical centers (outpatient)
Hospital outpatient department surgery centers
Inpatient hospitals
If your procedure is considered medically necessary to be performed in an inpatient setting, you may still find cost and quality variations between hospitals or facilities.
Log in to your account to use the Find a Doctor tool to compare facility cost and quality measures. You can also use the Blue Distinction Program (BDC)* filter to find those recognized for their safety, quality, and value. Members located outside of Washington and Alaska can use the national Find a Doctor tool.
Some employer-sponsored plans may offer enhanced benefits and savings for certain specialty procedures at designated locations. To get specifics on what your plan covers, sign in to check your benefit details.
*Blue Distinction Centers and Blue Distinction Centers+ have a proven history of delivering exceptional care and results. With two levels of recognition, you and your provider can choose the option that best meets your needs.
Outpatient cost
Inpatient cost
If outpatient care is right for you, you may be able to find significant cost savings without sacrificing quality.
Hospital outpatient department (HOPD) surgical centers are owned by larger hospital systems. They are located within the facility or at another campus.
They offer a wide range of services and have access to hospital resources if unexpected complications arise during surgery or before discharge. However, procedures done in hospital-based outpatient settings have higher out-of-pocket costs.
Find an accredited, in-network HOPD near you. Members located outside of Washington and Alaska can use the national Find a Doctor tool.
Ambulatory surgical centers (ASCs) are another type of outpatient surgical center. ASCs offer patients the convenience of having surgeries and procedures performed safely outside of an HOPD. These facilities are often owned by a group of physicians rather than being inside a hospital.
Because ASCs specialize in certain procedures, they build efficiencies that improve patient safety, experience, and outcomes. ASCs meet rigorous quality standards and have much lower costs than HOPDs.
Find an accredited, in-network ASC near you. Search for “ambulatory surgical centers” under the “Urgent Care and other Facilities” category. Members located outside of Washington and Alaska can use the national Find a Doctor tool.
When choosing a location for your procedure, be sure to review each location’s accreditations listed in the Find a Doctor tool. Accreditation is a designation process that ensures defined standards of quality are met. There are general accreditations and others that are specific to the center’s clinical specialties.
When common medical procedures are performed in a hospital outpatient department (HOPD) rather than an ambulatory surgical center (ASC), costs are substantially higher according to a national analysis from the Blue Cross Blue Shield Association.
The following are procedure cost differences that occurred for those visiting an HOPD compared to those receiving the same procedure at an ASC:
Use the Procedure Cost feature in the Find a Doctor tool to easily compare the prices of medical services from providers in your plan’s network.
Learn more about cost-saving ambulatory surgical centers and your benefits.
Call the customer service phone number on the back of your ID card.
