Why Do Patients Get a Separate Bill for Anesthesia? 

When patients receive medical treatment or undergo a surgical procedure, they often receive multiple bills for different aspects of their care. One of these bills may be for anesthesia, the part of the medical procedure that protects patients from feeling pain (1). Anesthesiologists are medical doctors who specialize in administering anesthetics and monitoring patients during surgery. They are often employed by an anesthesia management company unaffiliated with the surgical facility and work alongside surgeons and other medical professionals involved in the procedure (6). As a result, patients typically receive a separate bill for anesthesias services. 

Anesthesiologists bill separately for their professional services when they are employed by an anesthesia services company that works alongside the surgery center or hospital but does not belong to the hospital. In total, patients are usually responsible for multiple bills, including the doctor’s bill, anesthesia bill, and surgical facility bill (6). This is because multiple entities are involved in the execution of a medical procedure like surgery. The surgeon or physician involved in the procedure is considered a separate entity from the anesthesiologist and even the surgery center or hospital where the procedure was performed, and thus there is a separate bill for anesthesia and the other components of care. 

Patients may receive one of three different types of anesthesia treatments: general anesthesia, local anesthesia, and regional anesthesia. General anesthesia renders a patient completely unconscious and immobile during a lengthy or invasive procedure (1). In contrast, local and regional anesthesia only affects a part of the body. Local anesthesia is used to numb pain in dentistry, dermatology, or ophthalmology procedures, while regional anesthesia is applied to larger areas such as the arm or legs and is commonly used during joint surgeries or childbirth (1). 

Billing varies for different kinds of anesthesia services. However, unlike most other medical services, which charge a flat fee, anesthesia services are provided on a time-based fee schedule (2). As a result, the cost of anesthesia can vary depending on the length and complexity of the procedure. In some cases, patients may also incur a separate pharmacy bill for medications and supplies used during the anesthesia process (3). This can include medical supplies such as IV fluids, medications to prevent nausea or side effects, the anesthetic gas itself, and other supplies that are necessary for the safe and effective administration of anesthesia (4). 

As calls for healthcare pricing transparency grow louder, patients may be able to obtain a clearer understanding of out-of-pocket costs for expensive medical procedures and avoid incurring fees that take them by surprise. In July 2022, the Transparency in Coverage Final Rule was passed, requiring health insurers to make pricing for covered services and items available to all members (5). Under this rule, insurers need to make the allowed and billed amounts they have agreed upon with both in-network and out-of-network providers easily viewable. The widespread availability of this information should, in theory, empower patients to predict their out-of-pocket costs. 

However, the required format for this pricing information is machine-readable files, which is difficult for the average consumer to understand (5). User-friendly formats are essential to making healthcare pricing more accessible and comprehensible, establishing true healthcare price transparency. In the meantime, patients should be aware of the reasons behind anesthesia billing practices and why they may receive a separate bill, and review their bills carefully to understand what services they are being charged for. By being proactive and informed about their medical expenses, patients can make better decisions about their healthcare and financial well-being. 


  1. “Anesthesia.” National Institute of General Medical Sciences, National Institutes of Health, 21 Jul 2022, www.nigms.nih.gov/education/fact-sheets/Pages/anesthesia.aspx 
  1. “Anesthesia Billing Basics: Considerations Checklist.” American Association of Nurse Anesthesiology, n.d., www.aana.com/docs/default-source/practice-aana-com-web-documents-(all)/anesthesia-billing-basics-considerations-checklist.pdf 
  1. “Billing for Hospital Anesthesia Services.” Sutter Health, n.d., www.sutterhealth.org/for-patients/anesthesia-billing 
  1. French, Katy, et al. ”Value Based Care and Bundled Payments: Anesthesia Care Costs for Outpatient Oncology Surgery Using Time-Driven Activity-Based Costing.” Healthcare (Amsterdam, Netherlands), vol. 4, no. 3, 2016, p. 173, https://doi.org/10.1016/j.hjdsi.2015.08.007.  
  1. Gordon, Deb. “New Healthcare Price Transparency Rule Took Effect July 1, But It May Not Help Much Yet.” Forbes, 3 Jul 2022, www.forbes.com/sites/debgordon/2022/07/03/new-healthcare-price-transparency-rule-took-effect-july-1-but-it-may-not-help-much-yet/ 
  1. Gorke, Jeff. “Surprise Medical Bills: Here’s What You Owe (…Or Do You?).” Forbes, 1 Jun 2019, www.forbes.com/sites/jeffgorke/2019/06/01/surprise-medical-bills-heres-what-you-owe-or-do-you/ 
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