Knee Replacement Cost with Humana: What You'll Actually Pay

At HCA Florida hospitals, Humana's negotiated rate for knee replacement runs $11,000. BayCare comes in higher at $16,144 for the same procedure.

These rates cover the facility fee only. That's the hospital's charge for the operating room, recovery room, nursing staff, and the implant itself. The surgeon bills separately. The anesthesiologist bills separately. Sometimes a surgical assistant bills separately.

The $5,144 difference between these two hospital systems matters if you haven't met your deductible yet. Every dollar the hospital charges Humana is a dollar that counts toward your deductible until you hit your plan's limit.

Humana pays the hospital their negotiated rate, then figures out what you owe based on your specific plan. If you haven't met your deductible, you pay the full negotiated rate until you do. If your deductible is $3,000 and you've already met $1,500 of it, you pay the remaining $1,500, then Humana's coinsurance kicks in.

Once you've met your deductible, you pay your coinsurance percentage of the negotiated rate. If your plan has 20% coinsurance and you're having the procedure at HCA Florida, you'd pay $2,200 of the $11,000 rate. At BayCare, that same 20% coinsurance means you pay $3,229. This assumes you've already met your deductible for the year.

The anesthesiologist bills separately from the hospital and frequently works as an independent contractor, not a hospital employee. This is the single biggest source of surprise bills for knee replacement patients. You pick an in-network hospital and an in-network surgeon, then get a $3,000 bill from an out-of-network anesthesia group three weeks later.

Humana's out-of-network rates for anesthesia run 40% to 60% higher than in-network rates, and your out-of-network deductible is usually separate from your in-network deductible. You start over at zero. Call the hospital's billing department two weeks before your surgery date and ask specifically which anesthesia group they use and whether that group is in Humana's network.

The surgeon also bills separately. Most orthopedic surgeons who perform knee replacements accept Humana, but verify before you schedule. The surgeon's fee typically runs $2,000 to $4,000, and that's subject to the same deductible and coinsurance rules as the hospital facility fee.

You're legally entitled to a written cost estimate before you commit to any scheduled procedure. The hospital must provide it within 3 business days of your request. This Good Faith Estimate breaks down what the hospital will charge, what your surgeon will charge, and what the anesthesiologist will charge. It also shows what you'll owe based on your specific Humana plan and how much of your deductible you've already met this year.