Shoulder Surgery in Miami: Cost, Insurance, and What to Expect

Shoulder surgery is often the next step when conservative treatments—like physical therapy, medications, or injections—no longer provide relief. Whether you’re dealing with a rotator cuff tear, frozen shoulder, or arthritis, it’s natural to wonder about the cost, insurance coverage, and recovery journey.

At Miami Shoulder Institute, our board-certified shoulder surgeons help patients understand not just the procedure itself, but the financial and personal aspects of surgery as well. The below information and guidelines are for general reference; please note that individual costs and treatment protocols will vary widely depending on the individual patient. 

Understanding the Cost of Shoulder Surgery in Miami

The cost of shoulder surgery can vary widely depending on the type of procedure, hospital or surgical facility, surgeon’s expertise, and post-op needs.

Average Cost Range in Miami

• Arthroscopic Shoulder Surgery: $7,000 – $12,000
• Rotator Cuff Repair: $8,000 – $15,000
• Total Shoulder Replacement: $20,000 – $35,000
• Reverse Shoulder Replacement: $25,000 – $40,000

💡 Note: These estimates may include surgeon fees, hospital charges, anesthesia, and post-op care. Out-of-pocket costs depend heavily on insurance coverage. Global packages for patients wishing to self-pay are available.

Does Insurance Cover Shoulder Surgery?

Most insurance plans do cover medically necessary shoulder surgeries, but coverage can vary. Most require prior authorization for elective procedures, even when medically necessary.

Factors That Affect Coverage

• Type of insurance (Medicare, private insurance, Workers’ Comp)
• Medical necessity documentation (imaging, prior conservative treatments)
• Specific plan limits and copays/coinsurance
• Annual Deductible

What Insurance Usually Covers

• Pre-surgery consultations
• Surgery itself (hospital & surgeon fees)
• Post-op physical therapy sessions
• Medications for recovery

💳 Tip: Always confirm coverage directly with your insurance provider before scheduling surgery. At Miami Shoulder Institute, our team assists patients with insurance verification to avoid surprises.

Out-of-Pocket Costs

Even with insurance, patients may face deductibles, co-pays, or coinsurance costs.

• Example: If your deductible is $2,000, you may pay that amount before coverage begins.
• Out-of-network care typically costs more, so choosing a surgeon within your plan saves money.

What to Expect Before, During, and After Surgery

Before Surgery

• Diagnostic imaging (X-ray, MRI)
• Pre-op clearance (blood work, EKG if needed)
• Meeting with your surgeon to discuss risks, benefits, and recovery timeline

During Surgery

• Most shoulder surgeries take 1–2 hours
• Arthroscopic procedures involve small portal incisions, while replacements may require larger open incisions
• Outpatient vs. inpatient depends on procedure complexity and patient health status

After Surgery

• Sling use for 2–64 weeks
• Pain management (medications, ice therapy)
• Physical therapy starts within 1–2 weeks
• Return to normal activities in 3–6 months

Physical Therapy and Recovery in Miami

Recovery is just as important as surgery itself. Miami offers a wide range of specialized physical therapy clinics for shoulder rehab.

Rehab Phases

• Weeks 1–6: Gentle passive motion & pain control
• Weeks 6–12: Active strengthening with resistance bands & light weights
• Months 3–6: Sport- or work-specific training

💪 Most patients report significant improvements in strength and mobility by 6 months post-surgery.