Demystifying Health Insurance for Surgery: A Guide to Common Terms

If you need surgery, now or in the future, understanding a few key terms can help you make smarter choices and possibly save you money on surgery costs.

Common Healthcare Terms To Know

And if you have access to Carrum Health, a perk offered by your company in addition to your health insurance, saving money on top-tier surgery is even easier.

  • In Network: Insurance companies negotiate rates with certain hospitals and doctors to form a “network.” Getting surgery from these providers costs less because of these special rates. “Out-of-network” potentially leads to higher charges. (Carrum Health’s network only includes the top 10% of surgeons throughout the country who have better outcomes and outstanding bedside manner.)
  • Copay: fixed fee for certain services (doctor visit, prescription, etc) paid upfront, separate from deductible and coinsurance. For example, you may have a $30 copay for a doctor’s visit. (With Carrum Health, you typically won’t have to worry about paying any copays, because most, if not all, costs are typically covered by your employer.)
  • Deductible: The amount you pay out-of-pocket before your insurance kicks in. Higher deductibles typically mean lower premiums, and vice versa.  (For those on a high deductible plan, once the deductible is met, there is typically no additional cost for the surgery.)
  • Coinsurance: your share of the bill after deductible, typically a percentage (For example, a 20% coinsurance means you pay 20%, the insurer pays 80%). (With Carrum Health, you typically won’t have to worry about paying any coinsurance, since most, if not all, costs are typically covered by your employer.)
  • Out-of-Pocket Maximum: This is the maximum amount you’ll spend in a year for covered healthcare services. After you hit it, your insurance typically pays 100% of covered services remaining in that year. (With Carrum Health, all surgery costs are typically paid by your employer. Unless you need to meet your deductible, you won’t have any out-of-pocket costs for surgery.) 
  • Second Opinion: Surgery is a significant step, and a second opinion will help you understand the details of your diagnosis and available treatment options.. (A second opinion from top-tier surgeons is included in your Carrum Health benefit.)
  • Pre-authorization: The green light from the insurance company who needs to confirms your surgery is medically necessary.
  • Typical surgery costs: Surgeon, facility and anesthesia fees are typically billed separately and insurance coverage may vary. (With Carrum Health, you won’t have to worry about paying these fees. All surgery costs are typically paid by your employer.) 

It’s always important to review your specific health benefits package and speak with your HR or benefits department to understand how your plan works, especially for surgeries or other significant medical procedures.

And if you have access to the Carrum Health benefit, you’ll typically pay much less for top-tier surgery.  Find out if the Carrum Health benefit is available to you. Check your eligibility.


The information contained on this page is for informational purposes only. No material is intended to be a substitute for professional medical advice, diagnosis, or treatment.