Latest / The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement / Episode 112: The Knee Replacement Costs Nobody Warns You About, Part 2 (Help at Home, Prescriptions, Equipment, and Therapy)

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Episode 112: The Knee Replacement Costs Nobody Warns You About, Part 2 (Help at Home, Prescriptions, Equipment, and Therapy) · The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement

• 0:00
  She had prescriptions to pick up, therapy visits
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  coming, and help at home to think about. And
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  she knew the bills from the surgery itself would
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  not necessarily arrive together. One might show
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  up this month and another weeks later. Are you
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  ready to get back to what you love after knee
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  replacement? The Total Knee Success podcast is
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  your trusted guide with practical tips, evidence
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  -based strategies, and no fluff. It's not personal
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  medical advice, just solid education to help
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  you manage pain. regain mobility, and get back
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  to living the life you love. Let's dive in. Welcome
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  back to the Total Knee Success Podcast. I'm Michelle.
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  In episode 111, we met Diane and followed her
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  through the expenses that can come up before
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  knee replacement and on surgery day. Now in part
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  two, we're picking up her story as she comes
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  home after surgery. Diane came home with her
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  discharge instructions, her walker, and all the
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  usual things. that suddenly seemed to take over
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  the house after knee replacement. The estimates
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  and notes she had gathered before surgery were
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  still where she had left them, organized on her
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  desk. Now there were new expenses to add to the
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  picture. A good friend of hers could stay with
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  her through the end of the week. Prescriptions
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  were waiting at the pharmacy. Physical therapy
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  started in a few days and the follow -up visit
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  the surgery center had scheduled for her was
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  coming up in about a week and a half. Diane looked
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  at what was already on her calendar and realized
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  that coming home had started a second wave of
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  expenses. She had prescriptions to pick up, therapy
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  visits coming, and help at home to think about.
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  And she knew the bills from the surgery itself
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  would not necessarily arrive together. One might
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  show up this month and another weeks later. That
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  was when the cost of knee replacement stopped
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  looking like one large number to Diane. Now it
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  looked like a series of smaller expenses, some
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  predictable and some not, arriving over time.
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  By the end of this episode, you'll have a better
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  idea of where to look for post -op costs and
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  which questions to ask. These are examples, not
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  a complete list, so your own costs will depend
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  on your care and coverage. Diane's story will
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  help you spot some of the money questions worth
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  asking and who may have the answers. Now let's
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  check back in with Diane to see where the first
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  of those expenses shows up. One quick reminder
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  before we get into the numbers. This episode
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  provides general education. Your health care
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  team determines your care and your insurer, pharmacy,
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  supplier, employer, and health care providers
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  must confirm the costs and the rules that apply
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  to your particular coverage. The first expense
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  Diane had to think about was help at home. Her
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  friend brought dinner one evening. Her brother
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  picked up a prescription. Her neighbor offered
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  to drive her to therapy. That help did not create
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  a bill. although Diane knew that friends and
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  family had schedules of their own and could only
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  cover certain days. Some people also receive
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  home health services after knee replacement.
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  That may include physical therapy, nursing, or
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  other skilled services in the home. How long
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  those services continue can vary considerably.
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  One person may receive home health for only a
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  few days, while another may receive it for a
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  couple of weeks or longer depending on the individual
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  situation, the plan of care, eligibility, and
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  insurance coverage. If you're in the United States,
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  ask whether home health has been ordered for
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  you, which agency will provide it, whether that
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  agency participates with your insurance, and
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  what you may owe. For people using Medicare,
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  Medicare's Care Compare can be used to look up
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  Medicare -certified home health agencies and
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  review information about their services and quality.
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  When that kind of help isn't enough, some people
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  may choose to pay for a short -term help at home.
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  If that's your situation, ask your insurance
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  plan about any coverage services and requirements.
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  For anything that's not covered, contact local
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  home care agencies and ask about self -pay rates,
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  minimum hours, and any extra fees. Diane's friends
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  and family could cover much of the everyday help
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  she needed during those first few days at home.
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  But there were still some gaps. Depending on
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  your situation, you may have short -term costs
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  for transportation, meal delivery, household
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  help, pet care, or other services. Fortunately,
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  many grocery stores deliver straight to your
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  home these days. These expenses may never appear
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  on a hospital estimate, but they can still add
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  to what knee replacement costs you at home. Some
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  households have another financial issue to consider.
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  A spouse, adult child, or friend may need to
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  take unpaid time away from work to help. Where
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  someone may need to pay for care, they would
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  normally provide for a child, parent, spouse,
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  or pet. Those costs rarely appear on a hospital
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  estimate, but they can affect the household budget
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  right away. Her next expense appeared at the
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  pharmacy. One prescription cost more than she
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  expected. Before paying, she asked the pharmacist
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  whether it had been processed through her plan
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  and whether that pharmacy participated in the
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  plan's network. Healthcare .gov explains that
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  medications on a plan's formulary or covered
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  drug list usually cost less than medications
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  outside it. Your insurer's website, coverage
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  documents, and member's services number can tell
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  you which prescriptions are covered and what
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  rules apply. A plan may place medications on
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  different cost tiers or require an exception
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  process for a drug it does not normally cover.
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  Those are coverage questions. They are never
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  instructions to change a medication. If a prescription
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  is expensive, unavailable, or rejected by the
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  plan, ask the pharmacist and the prescriber about
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  medically appropriate options. The prescriber
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  decides whether a different drug, dose, or duration
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  is appropriate. Diane wrote down what she paid
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  for each prescription so she could include the
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  amount in her running total. Diane had already
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  planned for the larger equipment she expected
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  to need before surgery. Now that she was home,
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  the equipment question was whether anything else
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  recommended by her healthcare team would create
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  another expense. Some people are sent home with
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  a cold therapy machine, sometimes with compression,
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  to use according to their healthcare team's instructions.
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  If one is recommended, ask whether it's being
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  purchased, supplied through insurance or the
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  surgical program, or paid for out -of -pocket
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  and what you may owe. Other people may be instructed
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  to use TED stockings or an interim pneumatic
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  compression device. If a compression device is
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  sent home with you, ask whether it's being purchased,
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  rented, or supplied through the surgical program.
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  what insurance covers, and whether the device
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  needs to be returned. If it is a rental, ask
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  when and how it must be returned so additional
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  charges do not continue. Other insurance plans
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  and suppliers have their own coverage and billing
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  rules. Before assuming an item is covered, ask
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  whether an order, prior authorization, or a particular
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  supplier is required and what your share of the
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  cost will be. There may also be smaller items
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  that make things easier at home. Depending on
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  your individual needs and what your healthcare
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  team recommends, that might include a reacher,
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  a long -handled bath sponge, a handheld showerhead,
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  or a long -handled shoehorn. These are often
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  the kinds of items people buy themselves, so
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  check what you already have and what's actually
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  recommended before spending the money. Those
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  smaller purchases may not seem like much individually,
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  but they might belong in your tally, too. With
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  equipment accounted for, Diane moved on to another
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  expense that could repeat, and that's appointments.
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  Before her first therapy visit, Diane asked the
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  therapy office for an estimate of what she might
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  pay. They were able to give her a ballpark. Your
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  hospital or therapy office may be able to do
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  the same, although it isn't always the final
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  amount. If you don't get an estimate, you can
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  ask if one's available. Either way, you can also
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  call your insurance plan and ask whether that
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  location is in network and how your deductible,
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  copay, or coinsurance would apply. A single copay
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  may sound modest until you place several visits
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  on your calendar. If someone paid a $40 copay
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  for eight visits, the arithmetic would mean $320,
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  and that's just an example. It's not the price
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  of therapy, a recommendation for eight visits,
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  or an estimate of what you might owe. Use your
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  own visit count and your own benefit information.
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  Ask whether your plan limits visits, requires
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  reauthorization after a certain point, or has
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  any other conditions that affect what you might
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  owe. The number and timing of therapy visits
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  are individualized. The surgeon may make recommendations
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  and the physical therapist works with the patient
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  to determine an appropriate schedule based on
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  the person's needs and progress. If cost is affecting
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  your care, talk with your physical therapist.
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  They can't change your insurance, but they do
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  want to know so they can problem solve with you
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  and strategize around your individual situation.
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  For people with traditional Medicare, Part B
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  helps pay for medically necessary outpatient
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  physical therapy. In 2026, there is a $283 annual
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  Part B deductible. After that deductible is met,
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  you generally pay 20 % of the Medicare approved
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  amount, although other coverage you have can
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  affect what you actually pay. There's also a
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  therapy threshold. In 2026, once Medicare approved
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  physical therapy and speech -language pathology
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  expenses combined reach $2 ,480, Medicare requires
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  additional documentation showing that continued
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  therapy is medically necessary. That's something
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  your therapist and therapy office handle, and
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  reaching the threshold does not automatically
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  mean therapy stops. I'm specifically talking
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  about traditional Medicare here. If you have
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  a Medicare Advantage plan through a private insurance
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  company, your copays, coinsurance, network requirements,
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  and authorization rules can be different. So
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  check your individual plan. These are general
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  Medicare rules, but I don't know the details
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  of your coverage. Your costs can be affected
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  by your specific plan, other insurance you have,
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  the provider, and where you receive physical
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  therapy. You need to check your own Medicare
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  or insurance information before relying on any
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  other dollar amount we've discussed here. I've
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  put links to the official Medicare and CMS information
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  in the episode article so you can check the current
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  rules yourself. The location of therapy can affect
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  the bill as well. A hospital outpatient department
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  and a private therapy office may use different
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  billing arrangements even when the appointment
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  feels similar to the person receiving care. Ask
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  the insurer what you may owe at the specific
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  location on your schedule. The street address
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  and the provider name give the representative
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  something concrete to check. For Diane, therapy
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  also came at the cost of getting there. She was
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  following her healthcare team's driving instructions,
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  and she was not ready to drive herself. Her neighbor
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  offered rides for the first few visits. Another
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  person may have to pay for parking, use a ride
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  service, or arrange appointments around someone
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  else's work schedule. That transportation cost
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  can be money, time, or both. Diane wrote the
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  rides besides the therapy appointments because
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  the calendar gave her a more complete total than
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  the copay alone. She used the same approach for
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  her surgical follow -up. She checked whether
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  the visit was included in the surgical package,
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  whether any imaging would be billed separately,
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  and whether the office collected a copay. The
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  office and insurer had to answer those questions
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  for her particular appointment because the phrase
• 11:39
  follow -up visit alone does not identify the
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  cost. If recommended care is becoming difficult
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  to afford, tell the person treating you and their
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  billing office. Ask what your plan covers and
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  whether the office can explain the charges. The
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  number and timing of visits belong to your individual
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  plan. Diane's calculation was there to help her
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  budget, never to decide how much care she really
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  needed. Several weeks later, Diane had an explanation
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  of benefits, often called an EOB, a bill, and
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  a receipt. An explanation of benefits is not
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  a bill. It's the insurer's summary, a quick look
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  at what was charged and how it was processed.
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  Then you match it against the bill and any receipts.
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  If the numbers don't match or something looks
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  like it was charged twice, call the provider
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  and or your insurance company before you pay
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  it. Diane kept a simple record of what she had
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  paid and when. Nothing fancy, just enough to
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  keep track of the bills and catch something that
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  didn't look right. If a bill is more than you
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  can afford, call the billing department and ask
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  about your options. Some hospitals and healthcare
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  facilities offer financial assistance or payment
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  plans. The rules vary, so ask what's available
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  and ask how to apply. That brings our two -part
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  cost story to a close. Episode 111 covered before
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  and surgery day. This one followed the after.
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  The goal is to help you see where the money may
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  go and ask clear questions with your own details.
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  I hope this episode has helped you learn a little
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  bit more about what you might expect and help
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  you find out more information if you've had some
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  worry about it. Next time, we're getting back
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  to the clinical side with a new four -part walking
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  series. In episode 113, we'll start with walking
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  with a walker after knee replacement. Then we'll
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  move to walking with a cane, stairs and curbs,
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  and finally hills, grass, and uneven ground.
• 13:36
  If you'd like updates and resources, you can
• 13:38
  join the free Total Knee Success Insider Newsletter.
• 13:41
  The link is in the show notes. Thanks for joining
• 13:44
  me. I'm Michelle, and this has been the Total
• 13:46
  Knee Success Podcast. This podcast is for educational
• 13:53
  purposes only. Discover more at TotalMeSuccess
• 13:57
  .com and be sure to subscribe and share because
• 14:00
  every step forward takes you closer to living
• 14:03
  the life you love.