Memorial Hermann's Role in Your Hysterectomy Coverage

Memorial Hermann is a hospital system in Texas, and like all hospitals, it accepts Medicare. Whether Memorial Hermann will perform your hysterectomy depends on whether your doctor has privileges there, whether the procedure is medically necessary, and whether Medicare covers it — not on a separate decision by the hospital itself.

Medicare Part B covers hysterectomy when a doctor documents that it is medically necessary. The hospital bills Medicare directly for the facility costs (the operating room, anesthesia, nursing staff). Your out-of-pocket costs depend on whether you have supplemental coverage and what your deductible status is for the year, not on which hospital you choose.

The real question is not whether Memorial Hermann "assists" — it is whether your surgeon operates there and whether your insurance will cover the procedure at that location.

Key Takeaways

  • Medicare Part B covers hysterectomy when a doctor determines it is medically necessary, regardless of which hospital performs it.
  • You will owe your Part B deductible (if you have not met it for the year) plus 20 percent of the Medicare-approved amount for the surgeon's fee.
  • The hospital facility charges are separate from the surgeon's charges, and both go through Medicare's payment process.
  • Before scheduling, confirm with your surgeon's office that they have operating privileges at the Memorial Hermann location you plan to use.
  • Call Memorial Hermann's billing department or your Medicare plan to understand what your specific out-of-pocket costs will be.

How Medicare Pays for Hysterectomy at a Hospital

When you have a hysterectomy at Memorial Hermann, two separate bills are generated. Your surgeon submits one bill to Medicare for the surgical service. Memorial Hermann submits a second bill for the facility — the operating room, recovery room, anesthesia, and nursing care.

Medicare Part B pays 80 percent of the approved amount for both bills, after you meet your annual deductible ($240 in 2024, though this amount changes yearly). You are responsible for the remaining 20 percent of the approved amount, plus any charges above what Medicare considers reasonable.

If you have a Medigap policy (supplemental insurance), it typically covers your 20 percent coinsurance. If you have a Medicare Advantage plan instead of Original Medicare, your costs work differently — your plan sets its own copays and coinsurance, and you should contact your plan directly to learn what you will owe.

Confirming Your Surgeon Has Privileges at Memorial Hermann

Your gynecologist or gynecologic surgeon must have operating privileges at the specific Memorial Hermann location where your surgery is scheduled. This is not something the hospital decides on a case-by-case basis — either your doctor operates there or they do not.

Ask your surgeon's office which hospitals they use. If your preferred surgeon does not have privileges at Memorial Hermann, you have two options: schedule at a hospital where they do operate, or ask your surgeon for a referral to another surgeon who does operate at Memorial Hermann.

You can also call the Memorial Hermann location directly and ask whether a specific surgeon has privileges there. The hospital operator can transfer you to the medical staff office or surgery scheduling department.

Understanding Your Out-of-Pocket Costs

Your actual cost depends on three things: whether you have met your Part B deductible for the year, whether you have supplemental insurance, and what the Medicare-approved amount is for the procedure at that location.

If you have not met your $240 deductible, you pay that first. Then you owe 20 percent of the approved amount for both the surgeon's bill and the facility bill. For a hysterectomy, the facility charges are often larger than the surgeon's charges, so your 20 percent coinsurance can be several hundred dollars.

If you have Original Medicare with no Medigap policy, you pay the full coinsurance yourself. If you have a Medigap plan, it covers most or all of this coinsurance — check your policy documents or call your Medigap insurer to confirm. If you have a Medicare Advantage plan, call your plan to learn your copay or coinsurance amount, because it varies by plan.

What to Do Before Your Surgery

Contact Memorial Hermann's patient financial services or billing department at least two weeks before your scheduled surgery. Give them your Medicare number and ask for an estimate of the facility charges. This is not a may provide of what you will owe, but it gives you a realistic number.

At the same time, contact your surgeon's billing office and ask for an estimate of their charges. Add the two estimates together, subtract what Medicare will pay (80 percent of the approved amount), and you have a rough idea of your responsibility.

If you have a Medigap or Medicare Advantage plan, also contact that insurer to confirm what portion they will cover. Some plans cover the full coinsurance; others cover part of it.

If You Cannot Afford the Out-of-Pocket Cost

Memorial Hermann has a financial information program for patients who cannot afford their bills. Contact the hospital's financial counselor or patient advocate before your surgery — not after. They can discuss payment plans, reduced rates for uninsured or underinsured patients, or other options.

You can also ask your surgeon's office whether they offer payment plans for their portion of the bill. Many practices do.

If you are struggling with Medicare costs in general, your State Health Insurance information Program (SHIP) offers free counseling. You can find your state's program by calling 1-877-839-2675 or visiting shiptalk.org.

Frequently Asked Questions

Will Memorial Hermann refuse to do my hysterectomy if I am on Medicare?

No. Medicare is accepted at all hospitals, including Memorial Hermann. The hospital cannot refuse to treat you because you have Medicare. What matters is whether your surgeon has privileges there and whether the procedure is medically necessary.

Do I need to get permission from Medicare before my hysterectomy?

No. Medicare does not require pre-approval for hysterectomy. Your doctor determines whether it is medically necessary, and Medicare pays based on that information. You do not need to contact Medicare beforehand.

What if my surgeon wants to do the surgery at a different hospital?

You can ask your surgeon whether they have privileges at Memorial Hermann. If they do not, you can either switch to a surgeon who does operate there, or have your surgery at the hospital where your surgeon works. The choice is yours.

Will my costs be different at Memorial Hermann than at another hospital?

Possibly. Different hospitals charge different facility fees, and Medicare's approved amount varies slightly by location. Your surgeon's fee is the same regardless of location. Call both hospitals' billing departments and ask for an estimate to compare.

What happens if the bill is higher than the estimate?

Contact the hospital's billing department when ready. Ask them to review the charges and explain any differences. If you believe there is an error, you can file an appeal with Medicare. Your SHIP counselor can help you with this process.