The main things to settle before your surgery date
Before you book an elective surgery, you need to know three things: whether your insurance will cover it, what the facility charges, and whether the surgeon and anesthesiologist are in your insurance network. Most people skip one of these and discover the gap after surgery, when the bill arrives. The time to ask is now, when you can still change your mind or shop around.
Start by calling your insurance company with the specific procedure code (your doctor's office can provide it). Ask whether the procedure is covered, what your out-of-pocket cost will be, and whether you need pre-authorization—a written approval from your insurer before the surgery happens. Some insurers require this; others do not. If pre-authorization is needed and you skip it, your claim may be denied entirely.
Then call the facility where you plan to have surgery and ask for the facility fee—the charge for using the operating room, equipment, and staff. This is separate from what the surgeon charges. Ask whether the anesthesiologist is employed by the facility (in-network) or is an independent contractor (often out-of-network, even if the surgeon is in-network). Out-of-network anesthesia bills are a common source of surprise costs.
Key Takeaways
- Call your insurance company before scheduling to confirm the procedure is covered, what you will owe out of pocket, and whether pre-authorization is required.
- Ask the facility for the facility fee separately from the surgeon's fee, and confirm whether the anesthesiologist is in your insurance network.
- Request an itemized estimate from the facility and surgeon so you know the total cost before the surgery date.
- Schedule a pre-operative visit with your surgeon to discuss medical history, current medications, and what to expect before and after surgery.
- Arrange for someone to drive you home and stay with you for at least 24 hours after surgery, since you cannot drive after anesthesia.
Getting a cost estimate in writing
Do not rely on a verbal estimate. Ask the facility to send you an itemized estimate that breaks down the facility fee, surgeon fee, anesthesia fee, and any other charges. The estimate should also show what your insurance will cover and what you are responsible for. This document protects you if the final bill differs significantly.
If the estimate seems high, you can ask whether the facility offers a discount for self-pay patients or whether the surgeon has a lower fee at an outpatient surgery center instead of a hospital. Outpatient centers are often less expensive than hospitals for the same procedure, though not all surgeons have privileges at both.
Keep the estimate and bring it with you on surgery day. If the final bill is substantially higher, you have documentation of what you were quoted.
What happens during the pre-operative visit
Your surgeon will schedule a visit before surgery to review your medical history, current medications, and any allergies or previous reactions to anesthesia. This is also when you ask questions about the procedure itself—how long it takes, what the recovery timeline looks like, and what restrictions you will have afterward. Write down the answers so you do not forget them.
The surgeon will also order pre-operative tests if needed: blood work, an EKG, or a chest X-ray, depending on your age and health. These tests confirm you are healthy enough for surgery. If the tests show a problem, the surgery may be postponed until it is addressed.
You will also meet with the anesthesiologist or a nurse anesthetist, who will ask about your medical history and any previous anesthesia experiences. Tell them about any medications you take, including over-the-counter drugs and supplements. Some medications interact with anesthesia or increase bleeding risk and need to be stopped before surgery.
Medications and food before surgery
Your surgeon will give you written instructions about which medications to take or stop before surgery. Do not skip this step or assume you know what to do. Some medications—like blood thinners, aspirin, or certain diabetes drugs—need to be stopped days before surgery. Others, like heart or blood pressure medications, should be taken the morning of surgery with a small sip of water.
You will also receive instructions about fasting: typically, no food after midnight the night before surgery, and no clear liquids after a certain time in the morning. Fasting is required because food in your stomach increases the risk of aspiration (inhaling stomach contents) during anesthesia. Follow these instructions exactly, even if you are hungry.
If you forget whether to take a medication or are unsure about the fasting window, call your surgeon's office the day before surgery. Do not guess.
Arranging transportation and recovery time
You cannot drive yourself home after surgery because anesthesia impairs judgment and reaction time for at least 24 hours. Arrange for someone to pick you up and stay with you for the rest of the day. If you live alone, ask a friend or family member to stay overnight so you have help if you need it.
Plan to take time off work. Even minor outpatient surgery usually requires a few days of rest. More complex procedures may require weeks. Ask your surgeon how long you should expect to be off your feet and when you can return to normal activities. Do not assume you will feel well enough to work the next day.
Before surgery, prepare your home: stock your refrigerator with easy foods, set up a comfortable place to rest, and make sure you have any prescribed pain medications filled ahead of time. You will not want to run errands after surgery.
Understanding what happens on surgery day
Arrive at the facility at the time you are told—usually 1 to 2 hours before the scheduled surgery time. You will check in, change into a hospital gown, and have an IV placed. A nurse will review your medical history again and ask you to confirm the surgery site (the surgeon will also mark it with a pen). This repetition is intentional: it prevents wrong-site surgery.
You will meet the anesthesiologist or nurse anesthetist again, who will explain what will happen during anesthesia and answer any last-minute questions. You can ask about pain management after surgery and whether you will wake up in the recovery room or go directly to a hospital room.
The surgeon will also visit to answer any final questions and confirm you understand what is happening. Once you sign the consent form, you are ready for the operating room.
What to expect after surgery
You will wake up in a recovery room with a nurse monitoring your vital signs. You may feel groggy, nauseous, or cold—all normal effects of anesthesia. The nurse will give you pain medication if you need it and will monitor you until you are alert enough to go home (for outpatient surgery) or to a hospital room (for inpatient surgery).
Before you leave, the facility will give you written discharge instructions: what medications to take, what activities to avoid, what symptoms mean you should call the surgeon, and when to schedule a follow-up visit. Read these carefully and ask questions if anything is unclear. Keep them handy for the first few weeks of recovery.
You will likely have some pain, swelling, or bruising at the surgery site. This is normal. Call your surgeon if you develop fever, severe pain that does not improve with medication, excessive bleeding, or signs of infection (increasing redness, warmth, or pus).
Choosing between a hospital and an outpatient surgery center
Hospitals and outpatient surgery centers both perform elective surgery, but they differ in cost, setting, and what happens if complications arise. Hospitals are more expensive but have more resources on-site if something goes wrong during or after surgery. Surgery centers are usually less expensive and have a faster discharge process, but they are designed for straightforward procedures in healthy patients.
Ask your surgeon whether the procedure can be done at both a hospital and a surgery center. If it can, compare the facility fees and your out-of-pocket costs. Also ask about the surgeon's complication rate at each facility—some surgeons have better outcomes at one location than another, though this information is not always publicly available.
If you have significant medical problems or are having a complex procedure, a hospital may be the safer choice. If you are healthy and having a routine procedure, a surgery center may be adequate and less costly.
Frequently Asked Questions
Do I need pre-authorization from my insurance before scheduling surgery?
Some insurance plans require it, others do not. Call your insurance company with the procedure code and ask. If pre-authorization is required and you do not get it, your claim may be denied. If it is not required, you do not need to wait for approval, but you should still confirm coverage and your out-of-pocket cost.
What if I cannot afford the out-of-pocket cost?
Talk to the facility's financial counselor before surgery. Many hospitals and surgery centers offer payment plans, discounts for uninsured patients, or financial hardship programs. Some also have charity care funds. Ask what options are available.
Can I eat or drink anything before surgery?
Follow the fasting instructions your surgeon gives you exactly. Typically, no food after midnight and no clear liquids after a few hours before surgery. Fasting prevents aspiration during anesthesia. If you accidentally eat or drink, tell the anesthesiologist before surgery—they may need to postpone it.
What medications should I stop before surgery?
Your surgeon will tell you which medications to stop and when. Do not stop any medication on your own without asking first. Blood thinners, aspirin, and some supplements need to be stopped days before surgery, but heart and blood pressure medications usually continue. Call your surgeon's office if you are unsure.
What if I develop complications after I go home?
Your discharge instructions will list symptoms that require a call to your surgeon: fever, severe pain, excessive bleeding, signs of infection, or difficulty breathing. Call during business hours if possible, or go to the emergency room if symptoms are severe. Do not wait to see if it improves on its own.