Two Level ADR U.S. Pay out of Pocket

[colorado babe]

Originally Posted by Cynlite

Thanks for the updates. Hopefully, I have all the information correct now but, if I don't please let me know. I update the information in all places I put the spreadsheet so people don't run across older copies and rely on that information.

I also had a fusion at L5/S1.

[Cynlite]

Okay, back to the drawing board. I'll fix the spreadsheet again. You are making me work! I'm amazed at the price of your surgery! Just so I get it right... you had a 2 Level Mobi-C and a 1 Level fusion so, you had a hybred surgery right?

[colorado babe]

Originally Posted by Cynlite

Okay, back to the drawing board. I'll fix the spreadsheet again. You are making me work! I'm amazed at the price of your surgery! Just so I get it right... you had a 2 Level Mobi-C and a 1 Level fusion so, you had a hybred surgery right?

I don't think it was a hybrid surgery. I've never been told that. The mobi-C's were placed at the C5-7 and the Fusion was in my lumbar at L5/S1.
I checked all my EOB's and this is what it cost. I'll triple check again!

[colorado babe]

Northern CO Anesthesia Professional's: $2, 646.00 Allowed: $521.41
Northern CO Surgical Association: $3,835 Allowed: $975.27
Rocky Mountain Associates and Ortho MED PC (Assistant Surgeon): $2880 Allowed$244.97
Poudre Valley Hospital: $110, 259.65, Allowed: $21,786.27
Rocky Mountain Associate & Ortho MED PC: 15, 589.00 Allowed: $2,420

Total paid by insurance: $25,861.85
Correct Total Paid by Insurance: 25,947.65

Triple checked. I put the wrong amount paid by insurance for Northern Colorado Surgical Association. Insurance paid $975.27

That is all the bills I have received up to date.
The only thing I am thinking is that my surgeon and the hospital agree to pay a reduced rate for retired military. That is probably the reason why my surgery was so cheap. I have Tricare Prime insurance.

[JeffR]

I was confused because you quoted costs higher than what you insurance company paid out. Usually the patient pays the difference, but I'm guessing your insurance got the cost down, not sure why you included those costs then as they are apparently irrelevant. FYI you got a VERY good deal on your procedure.

[colorado babe]

Originally Posted by JeffR

I was confused because you quoted costs higher than what you insurance company paid out. Usually the patient pays the difference, but I'm guessing your insurance got the cost down, not sure why you included those costs then as they are apparently irrelevant. FYI you got a VERY good deal on your procedure.

I wanted to show how much insurance was charged and how much they allowed. This is typical practice in the United States.

As far as the surgery went, I should have never had to fight three appeals. The injuries that I incurred all happened on active duty. It's a shame that veteran's have to fight for there healthcare and then to be turned down 3 times is just to much. I am glad I fought and won. I hope it helps other's in the future.

[colorado babe]

Originally Posted by Cynlite

Thanks for the updates. Hopefully, I have all the information correct now but, if I don't please let me know. I updated the information in all places I put the spreadsheet so people don't run across older copies and rely on that information.

BTW, Colorado Babe, I think you are winning the price war on cervical disc replacements. You just beat out our lowest European price. It's really good information to know that your hospital and Top Doc accepted that amount in the U.S.! I think that the amount "allowable" was determined by Medicare but, it could have been a negotiated rate by your insurance company. I'm not sure every hospital and doctor would accept that amount since it's a negotiated price but, still really good leverage.

My insurance will not cover me out of state because it's a Medicare HMO (I'm on disability) so, I think an appeal would most likely be useless since this restriction is stated up front. I am only covered out of state if it's an emergency. However, I may give Dr. Pettine's office a call when all is said and done. Now, my big question will be is it worth paying the extra money going to Europe to get the M6-C?

I think you should still fight. You never know right? I agree with some others have said..If the cost of the procedure is close to what is offered overseas, why wouldn't you go? However, if it is cheaper to stay here in the states, I would just get it done here.

It's been 6 months now with my mobi-c's and I am so happy with the new disc. My migrane's have gone away and I have no issues with my neck anymore. I do have some issues with the fusion (sometimes sciatica and pain) but nothing like I experienced before. I am glad I didn't get the Pro-disc at the L5/S1 and just so happy that I have my life back. My surgeons, Dr Pettine and Techy have given me my life back. They are the best as far as I'm concerned.

[JeffR]

Originally Posted by colorado babe

I wanted to show how much insurance was charged and how much they allowed. This is typical practice in the United States.

As far as the surgery went, I should have never had to fight three appeals. The injuries that I incurred all happened on active duty. It's a shame that veteran's have to fight for there healthcare and then to be turned down 3 times is just to much. I am glad I fought and won. I hope it helps other's in the future.

That's brutal - both your personal circumstances and the US insurance price inflation.

[Cynlite]

Colorado Babe ~ There are a few things I'm considering besides cost when it comes to surgery. I have to make cost not be a deciding factor on where I'll go because I have to put my future health first. But, I think you are right in that appealing the insurance company when all is said and done makes sense. (BTW, I removed you as a hybrid on the spreadsheet because I think that means an ADR next to a fusion.)

I could get the Mobi-C surgery here in Arizona but, I'm not thrilled with the surgeons here so far. I need to keep exploring my options though and try not to taint my decision before I have all the information. So, far all I have gotten is disappointment in my home state because they always say fusion. Dr. Yeung, who I think is one with the most ADR experience here is a Pro-Disc doctor. Because of the HO rate and all the failed surgeries I've read about with this disc, I'm not even going to consider it. So, it's down to the M6-C and the Mobi-C. (BTW, one surgeon thinks I need two discs replaced but, they are not adjacent so, a surgeon with experience doing two adjacent levels with the Mobi-C is not an issue for me.)

I traveled six times to Pittsburgh already for spinal surgery so, I have that experience behind me. It really wasn't pleasant as you can imagine and this has been a long hard road of suffering. I know you get that too! I want to make sure that when I have surgery this time, it will be my best shot at my last time! These are the things I'm thinking about:

Surgeon - Who is the best surgeon to give me the best shot at recovering? I think Dr. Pettine is one of them so, I haven't ruled him out. I think there are three really good ones in Europe as well. The three in Europe have so much experience it's kind of hard to stack anyone in the U.S. up against them. But, like I said before, I won't proceed with surgery until I have explored all my options in the U.S. too.
Disc - What disc is going to give me the lowest HO rate and avoid further degeneration of my spine? I don't have enough information to compare the Mobi-C and M6-C. I just know that in Europe, they use the M6-C more often and the fact that it is self constraining is a selling point.
Physical Therapy - I've read and believe that immediate physical therapy after surgery is critical to the healing process. Dr. Bierstedt charges an extra $2000 euro over Dr. Clavel and I'm pretty sure it's to cover the cost of PT. He offers a very extensive PT program. Here's what his rep said to me "Post-surgical rehab is very beneficial and has a significant impact on the final success of the surgery. The extended stay gives us the chance to supervise for 2 weeks post-surgery including wound control and final check up. That patients would only stay 1-2 days as in-patient and then send home without further close supervision is almost unethical. This procedure is rather associated with costs and legal responsibility – factors that are not really having the focus on the patients well-being and care." I don't know what the other European doctors offer when it comes to PT. In the U.S., many people don't start P.T. until six weeks after surgery. I kind of like Dr. Bierstedt's approach that includes a daily program with massage and guided stretching to wake up the body. I wish we had something like that here.

I am so appreciative of you sharing your experience with me and offering your thoughts and suggestions. Knowing that your migraines went away is huge. I just spent the last two days in bed again because of them. They have completely crippled my life so I cannot make any plans whatsoever. The headaches on top of all the other pain are just a bi***! Every time I read of someone who no longer has them, it makes me happy and gives me hope. I would not wish them on my worst enemy.

I know the experience that you and several others have shared with me is truly invaluable so, THANK YOU, THANK YOU, THANK YOU!

[Cynlite]

Jeff ~ Both the numbers that Colorado Babe posted are relevant. Here's why,

I had to really fight hard to get disability (turned down twice) but, when I got it, with it to my surprise came Medicare insurance. It is truly a blessing I don't take for granted. Prior to getting disability, I was paying for private pay health insurance that went up 370% over five years. I was out of work and having surgery after surgery. Fortunately, I had a hefty savings account at the time to get me through it but, I went through every cent of it plus some! What I was paying for by getting health insurance was the negotiated rates the insurance company had with the doctors and hospitals that Colorado Babe mentioned in her post and a cap. My insurance didn't help me much at the time until I was out of pocket $7,500 in a year because that was my cap. I had to pay full fare when I went to a specialist or doctor PLUS pay the huge monthly insurance premiums.

Here's the really sad thing in this country and why so many people with medical problems can quickly go bankrupt. If you don't have health insurance, then the doctors and hospitals come after the individual for the billed amount NOT the allowable amount. The amount she posted over $100 K is what would hit the poor individual's credit that didn't have insurance and had the surgery. This wouldn't happen with elective surgery because they would just turn you down and you would get to suffer with your back/neck pain unless you could negotiate payment terms. But, if you happen to get in a car accident for example and end up in the hospital without insurance and they do surgery to save you, they will come after you for the full ticket!

I learned that prices for procedures are all over the board for the SAME procedure. It pays to shop around if you have to pay cash because insurance isn't helping bring the costs down. I really wish that Health Insurance was a regulated business in this country! Having lived through the hell of having creditors call me constantly to pay for medical bills I didn't have the money to pay for, I am all for the Healthcare Act even though it's not perfect! Insurance companies have us by the tail and there should be a standard price for medical costs IMO. (One place charges $100 for a mammogram and another $400....how do they justify that? Oh wait, they don't have to!) People need to have health insurance and even then, it's still not an easy road to travel financially speaking.

People need to understand that healthcare bills are negotiable. After I got disability, I went back and paid my bills but, for the most part, I only offered to pay 50% of what they billed me and they gladly took it. After that, the bill was off my credit.

When I worked, I had great health insurance and long term care insurance. I never thought a day would come when I wasn't covered. I never imagined when I was healthy that I would become so crippled and not be able to work. I was laid off from my job after 10 years and wasn't worried because I had a huge savings account so, I took time off from working to be a caregiver/patient advocate for my Mom and Grandma through their health crisis-es. Then, a few years later my issues with my neck and back got chronic and I was really in a bind not having a job with healthcare benefits and long term disability insurance!