Dilation and Curettage (D&C) is a surgical procedure used to remove tissue from the uterus. It is frequently performed following a miscarriage, to diagnose conditions like abnormal uterine bleeding, or as part of an abortion. Determining the final cost of a D&C, even with health insurance, is rarely straightforward due to the complexity of medical billing and coverage. The amount a patient is responsible for can range from nearly nothing to several thousand dollars, making a precise estimate challenging.
The Total Billed Cost Before Coverage
The initial price a facility charges for a D&C, often called the total billed cost, is highly variable across the healthcare system. Without insurance or negotiated discounts, the charge can range from approximately $2,000 to over $15,000. This wide range depends significantly on the facility’s location and its internal pricing structure. Hospitals, for instance, typically have much higher initial charge masters than specialized clinics.
This total billed amount is generally not what a patient with insurance will pay, nor is it what the insurer will pay. Insurance companies negotiate a much lower, contracted rate with in-network providers and facilities. The difference between the total billed cost and this negotiated rate is a discount the provider accepts. The patient’s actual liability is calculated from this reduced, negotiated rate.
How Your Insurance Plan Determines Your Out-of-Pocket Cost
The final amount a patient pays is determined by the specific structure of their insurance plan and how the procedure’s cost interacts with their annual benefits. The primary factor is the deductible, which is the amount a patient must pay out-of-pocket before the insurance plan begins to cover medical expenses. If the D&C is performed early in the year, a patient with a high deductible may be responsible for the entire negotiated charge up to that limit.
Once the annual deductible has been met, the insurance plan’s co-insurance percentage takes effect. Co-insurance represents the split of costs between the patient and the insurer, typically an 80/20 or 90/10 split. The patient pays the smaller percentage of the remaining negotiated charge. For example, if the negotiated rate is $5,000 and the patient has met their $1,000 deductible, a 20% co-insurance means they pay 20% of the remaining $4,000, or $800.
Copayments, or fixed fees for specific services, are less common for surgical procedures like a D&C but may apply to the initial consultation or follow-up visits. A separate specialist copay might be required for the surgeon’s fee. The ultimate financial protection for the patient is the annual out-of-pocket maximum, which is the ceiling on the total amount a patient must pay for covered services during the plan year. Once a patient reaches this maximum, the insurance company covers 100% of all subsequent covered medical costs.
Key Factors That Influence the Final Price
The physical location where the D&C is performed is a primary influence on the total cost. A procedure performed in a hospital operating room is almost always the most expensive option due to high overhead costs and facility fees. Ambulatory Surgical Centers (ASCs) typically offer a lower cost setting, while a D&C performed in a doctor’s office is often the least expensive choice.
The geographic area also plays a significant role, with costs generally being higher in major metropolitan areas compared to rural regions. This reflects differences in local market rates for labor, facility expenses, and medical equipment. The medical indication for the procedure, such as diagnostic sampling versus managing a miscarriage, can also affect the billing and the specific Current Procedural Terminology (CPT) codes used.
The type of anesthesia administered is another variable that impacts the final bill. Procedures requiring general anesthesia involve the services of an anesthesiologist and specialized monitoring equipment, significantly raising the total cost. A D&C performed under local anesthesia or moderate sedation, often done in an office setting, will incur a much lower charge. The separate charges for the facility, the surgeon, and the anesthesia provider all combine to form the final price.
Steps to Get an Accurate Cost Estimate
Patients seeking a precise cost estimate should first contact the physician’s office to identify the specific procedure code used for billing. The common CPT code for a D&C is 58120, which is used for both diagnostic and therapeutic purposes. Requesting this code is the first step toward obtaining a personalized estimate.
Once the CPT code is secured, the patient should call their insurance company and request a pre-authorization or an estimate of benefits for that specific procedure. The insurer can use the code to calculate the estimated patient responsibility based on the remaining deductible and co-insurance for the year. It is imperative to verify that all involved providers—the surgeon, the facility, and the anesthesiologist—are considered in-network. Using an out-of-network provider, even unintentionally, can drastically increase out-of-pocket costs.
Patients must be aware that the final bill is often separated into multiple charges. These include a facility fee, a professional fee from the surgeon, and a separate bill from the pathology lab for tissue analysis. Confirming the network status for all potential billing entities is necessary to prevent unexpected balance billing. Requesting a written “Good Faith Estimate” from the facility can help anchor expectations for the final financial liability.