[Jack]

I have only seen his NP since surgery. The bill is broken into two parts. One from the physician's group and one for the hospital including OR, materials, room charges etc. His practice is hospital based as he is a department head. I have another apt in about 3 weeks and will do a little snooping then. My experience has been that the big money is made with procedures and not routine office visits. That seems to be where the biggest demand for PAs and NP are, leaving the physician for more procedural stuff. For instance, I see the NP at my pain management docs office. There fee is $110.00 per visit for self or insurance pay. Medicaid is about half that. The NP said they don't take new Medicaid patients. It is more of a case where over time the patient deteriorates to the point where they cannot work and end up on Medicaid. An existing patient will not be dropped just because they end up on medicaid. I had her MD inject my wrist for carpel tunnel 2 weeks ago. There initially was a mix up in insurance coverage and they said the fee at time of service would be $985.00. It took him <15 minutes to inject it. He does have office upkeep, 6 employees, and Liability insurance so his charges were not take home pay.

Family Practice, and Peds docs seem to lack procedures, work the hardest and make the least.

The breakdown for the neurosurgeon was:
Lumbar spine fusion $4,260.00
Lumbar spine fusion $2,540.00
Removal of spinal lamina $2,393.00
Insert spine fixation device $3,597.00
Apply spine prosth device $1,905.00
Removal of spinal lamina $1,413.00

Total $16,108.50 for just surgeons services.

I suspect there is a lot of cost shifting going on from medicaid to private and insurance pay but don't know the actual percentage. If I had to guess from the clientele in the waiting room at the hospital, I would say it is significant.

If we as a nation don't somehow get a grip on medical costs, I could envision having insurance coverage for overseas at one price and coverage at another price for services in the USA. Another approach would be a two or more tier level of services. Where the latest and greatest is only used for those that could pay the higher price. Or, say in a case like mine where an old fart with multi-level disease would be denied surgery and left on cheaper opioids and other meds.

It justs seems my total cost for 4 days of $68,801.00 was excessive.

If Harrison would allow it, I could white out names and places and post my bills.