Where you elect to have a covered surgical procedure performed can impact the cost of that procedure. We’re here to help you understand some of the factors that drive these differences in costs, and how you can get the best value on procedures covered by your Premera health plan.  

One significant factor to consider when you’re scheduling a procedure is understanding if it will be inpatient or outpatient.  

Inpatient:  

• Inpatient procedures tend to be more complex and involve more recovery time for the patient.  

• Inpatient procedures usually take place at a hospital, where it’s normal for a patient to spend one or more nights recovering and being monitored by staff.  

• Given the additional time and care involved, inpatient surgeries tend to be more expensive than outpatient procedures. 

• Examples of inpatient surgeries include heart surgery, lung surgery, and childbirth.  

Outpatient:  

• Outpatient surgeries are typically less taxing and time-consuming, and patients undergoing these procedures are released to go home the same day. 

• While outpatient procedures can be performed in a hospital setting, they can also be conducted at other facilities, such as ambulatory surgical centers. 

• Outpatient surgical procedures are usually less expensive than inpatient alternatives. 

• Knee surgeries, tonsillectomies, and colonoscopies are examples of procedures frequently performed in outpatient settings.  

Because of their more flexible nature, outpatient surgeries can take place in a few different settings. Among the most common of these settings are Ambulatory Surgical Centers and Hospital Outpatient Department Surgery Centers: 

Ambulatory Surgical Centers: 

• Ambulatory Surgical Centers exist outside of hospital systems and are often owned by groups of physicians with related specialties.  

• Because they typically specialize in a narrower range of procedures, Ambulatory Surgical Centers can introduce operational efficiencies that allow them to keep costs down and improve patient experiences while still meeting rigorous quality standards.  

Hospital Outpatient Department Surgical Centers: 

• Hospital Outpatient Department Surgical Centers are owned by hospital systems, though their physical location may not always be on a hospital’s campus.  

• While outpatient care at a hospital is generally less expensive than inpatient care, out-of-pocket costs for patients still tend to be more expensive than the same care at an Ambulatory Surgical Center, due to higher overhead costs.

To learn more about the differences between outpatient and inpatient care, the sites of service available for procedures, and how you can find the right site for your healthcare needs, visit Premera’s Surgery & Elective Procedures pages for Washington members or Alaska members. 

And if you have any questions about your care, how to find a healthcare provider near you, or what’s covered by your health plan, call us at the number on the back of your Premera ID card. We’re here to help.