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  #1  
Old 02-24-2010, 12:01 AM
Jack Jack is offline
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Default Finally received itemized bill for 1 level fusion

I was kind of shocked, correction really shocked. No complications, in on Monday, out on Thursday. Price $68,801.68. This was at a in network local hospital that is a non-profit (no income tax, no property tax, etc) and owns various properties around town like Hotels. Back before Lyndon Johnson's 'Great Society' got ushered through Congress such a price might be remotely justified but now days they don't do that many gratis cases what with medicare and medicaid. They are so flush with cash they can't find stuff to spend it on. The management office level is decorated to the nines. Equipment is state-of-the-art.

One point I have heard is that Medicaid re-emburses between 50% and 60% of standard and acceptable charges and they make up the rest on folks like me with private insurance.

The surgeons fee was $16,108.00. The cost of the titanium bolts, and pins for my L5-S1 fusion was $25,247.00, probably less than a pounds worth. These are not lumped charges. I have 5 pages of charges for Labs, Anesthesia, anestheologist ($2,840.00) which could have been less since a nurse anesthesis actually did the case. Her pay did not come out of his.

What really lights my fire is the bogus charges. I was charged $148.00 per day for O2 but never used O2. A 1000 ltr bag of L-R is $70.75 plus hoses and needles and stick fee.

I just can't see how these charges could possibly be accurate unless the hospital is robbing from me to pay medicaid and ER hits from those without insurance. The hospital does eat those charges.

By the way, I'm a little leary about making an issue out of this but insurance hasn't paid yet. After that the risk of some sort of delay over this issue would be less.

No wonder insurance charges are so much for surgery.
__________________
Suffered thru every non-surgical cure known without relief.
Pain management '06 to April '10,
Had minimally invasive PLIF with internal fixation on 12/28/09 for isthmic spondylolisthesis of L5-S1 (TDR contra-indicated) DDD at L3-4 & L4-5, All L-Spine doing well. Episodes of no pain at all. After being relatively pain free for 4 months, C-Spine gave up. MRI due 11-1
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  #2  
Old 02-24-2010, 11:15 AM
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Harrison Harrison is offline
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Wink

Jack, you raised some good points and thanks for sharing the details. Here's another thought: do you really think that they are intentionally overcharging?

What I've experienced personally and observed on this forum, medical billing is often messy - with mistakes made all over the place. You could be right, though, so let us know if you find out anything else....

So how are you doing? Maybe you can update us in another topic!
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"Harrison" - info (at) adrsupport.org
Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
Founder & moderator of ADRSupport - 2004
Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006
Creator & producer, Why Am I Still Sick? - 2012
Donate www.arthropatient.org/about/donate
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  #3  
Old 02-24-2010, 03:57 PM
2cool4U 2cool4U is offline
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Default Fee versus payment

Jack,

Hope you're doing well. I was wondering about the surgeon's actual reimbursement. The fee for my ADR was north of $10K, but insurance only paid him around $2K. I called his billing office to see if he had discounted me or given me any advantage. Their reply was "no, that's about what we usually get for a single level ADR." Wow! I mean, I'm in medicine and I'm very much involved in the business side, and I couldn't believe that 3 hrs from prep to closure and 3 post-op visits were only worth $2K of a total PAID amount of close to $50K.

So tell me again, how does lowering physicians' fees significantly lower the cost of medical care?

-tc-
__________________
L5-S1 rupture 11/04, left leg pain for 2 wks
Regular exercise/pain-free until 2007
L5-S1 degen. disease w/constant pain since 6/07
PT, ESI, SI jt injections, 3-level nerve root inj. x 2
Massage, heat, ice, TENS, etc
L5-S1 Charite Jan. 19th, 2009, very happy w/decision
New back pain in upper back though.
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  #4  
Old 02-25-2010, 12:02 AM
Jack Jack is offline
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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.
__________________
Suffered thru every non-surgical cure known without relief.
Pain management '06 to April '10,
Had minimally invasive PLIF with internal fixation on 12/28/09 for isthmic spondylolisthesis of L5-S1 (TDR contra-indicated) DDD at L3-4 & L4-5, All L-Spine doing well. Episodes of no pain at all. After being relatively pain free for 4 months, C-Spine gave up. MRI due 11-1
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  #5  
Old 02-25-2010, 11:48 AM
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Harrison Harrison is offline
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Jack, I think we would appreciate you posting this -- it's all in the name of education and transparency. Thanks for sharing.
__________________
"Harrison" - info (at) adrsupport.org
Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
Founder & moderator of ADRSupport - 2004
Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006
Creator & producer, Why Am I Still Sick? - 2012
Donate www.arthropatient.org/about/donate
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  #6  
Old 02-25-2010, 07:13 PM
2cool4U 2cool4U is offline
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Default Yes, thanks

Maybe because I was just so hopeful for recovery that I didn't care and probably because most of my ADR was covered except for my relatively high deductible as part of our self-insured HSA, but I never received an itemized list. My bills were one page after I paid the first few to arrive before the deductible was met. My local insurance company rep pre-approved the surgery and then negotiated the hospital portion down about 20% after the fact. I was never consulted to determine if things were correct. If asked, I would have complied since it was pretty easy to remember most of the stay. Probably wouldn't have noticed medication cost or date errors, but the big stuff could have been reviewed. I have no idea how much the hardware cost.

More people should review their charges and payments as you have. More people should know their costs up front. However, it's a daunting task for the uninitiated. I still rely on one of our key employees to guide me through saving money on simple things like lab tests and Rx's. Most doctors are too busy handling the clinical side to know exact charges, reimbursements, etc. We employ trained coders to review everything we do to make sure we charge exactly what was done. We recently had an external audit and things were deemed excellent with mistakes well below national standards. Still, they do occur.

One way to make people more accountable for monitoring their health care costs would be to make them responsible for a small portion of every bill without a deductible. It would keep people out of the ER for problems that can be handled by their PC during routine hours, since ER costs are much greater for treating the exact same problem. If I knew that going in tonight for that abdominal pain that I've having off and on for 6 months (yes, it happens millions of times per DAY in this country for millions of different routine problems) would result in $600 in charges for which I had to pay $60, but I could make an urgent visit to my internist in the morning for around $100 (costing me $10), then I'd only go if I couldn't take. There are lots of ER visits that are unnecessary, but no one cares b/c they've met their deductible.

Sorry, really didn't mean to go off on a rant, but I guess I'll leave it here. My point is more people should do what you did, but I'm a hypocrite here, huh. Meantime, how are things going? I was thinking about you today as I was realizing that if I had chosen fusion instead of ADR, I prob would've failed b/c of my unrecognized vitamin D deficiency. Make sure to consider that during your recovery. It's a much bigger problem than I or some of my docs knew. I wouldn't have believed myself if I hadn't experienced it and then followed up with a literature search. Just imagine what we know now compared to 50 yrs. ago, and imagine where we'll be 50 yrs. from now. I guess we can only do the best with the info we have right now. Just use it to the fullest. Take care.

-tc-
__________________
L5-S1 rupture 11/04, left leg pain for 2 wks
Regular exercise/pain-free until 2007
L5-S1 degen. disease w/constant pain since 6/07
PT, ESI, SI jt injections, 3-level nerve root inj. x 2
Massage, heat, ice, TENS, etc
L5-S1 Charite Jan. 19th, 2009, very happy w/decision
New back pain in upper back though.
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  #7  
Old 02-25-2010, 11:19 PM
Jack Jack is offline
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Join Date: Jul 2009
Posts: 120
Default

tc,

I'm gonna get a glass of milk and a multi-vit. I have been lax in this area.

I'm doing better than I would have thought. I can bend a little and lift a little but anytime I get over 12-15 pounds it starts hurting I have to lye down. At least it does get better in 30-60 minutes now where-as before surgery it doesn't. I still have bad days but not as many the further out from surgery I get.

Trying to taper off opioids right now is a bigger issue for me than residual back pain. The last bit is a lot harder than at first when it was a larger amount. I have been stuck on 30-40 mg of short acting for about a week now. I go through hell and back in the AM and then get better as the day and the blood level builds. It also is confusing at times as to what makes pain better, the surgery or the meds. I'm pretty sure it is the surgery but after wanting something so bad for 4+ years a person tends to not want to set themselves up for failure. There are so many factors, even placebo effect. I suppose what ever, it is a positive.

I have seven pages of single space charges. I'll get busy with the white out. I may have to do it in the form of a link as it might be a bit much to put it in a post.
__________________
Suffered thru every non-surgical cure known without relief.
Pain management '06 to April '10,
Had minimally invasive PLIF with internal fixation on 12/28/09 for isthmic spondylolisthesis of L5-S1 (TDR contra-indicated) DDD at L3-4 & L4-5, All L-Spine doing well. Episodes of no pain at all. After being relatively pain free for 4 months, C-Spine gave up. MRI due 11-1
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  #8  
Old 02-28-2010, 01:02 AM
2cool4U 2cool4U is offline
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Join Date: Oct 2008
Posts: 141
Default Do $$ affect treatment choice?

I had another thought on this topic. IF those surgeon fees are typical for fusion and my expenses are typical for single level ADR, where is the incentive for a surgeon to go to the trouble of learning the new technique and using it where appropriate? I know that it's all supposed to be in the best interest of the patient, but let's be honest, learning a new surgical technique takes time and money. If it will replace something you've been doing for many years and does so at less than 25% of what you receive while taking just as long to perform, who's going to adopt it?

I don't have the answers, just most of the questions.

And Jack, multivitamins usually contain 400 iu of vitamin D3. Just as an example, my physicians recommended 8,000 iu/day. Of course, I haven't seen sunshine here since November, and I was having a surprising number of unusual symptoms, so my dose was based on that. You can always get tested first to help with dosage.

-tc-
__________________
L5-S1 rupture 11/04, left leg pain for 2 wks
Regular exercise/pain-free until 2007
L5-S1 degen. disease w/constant pain since 6/07
PT, ESI, SI jt injections, 3-level nerve root inj. x 2
Massage, heat, ice, TENS, etc
L5-S1 Charite Jan. 19th, 2009, very happy w/decision
New back pain in upper back though.
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  #9  
Old 03-01-2010, 10:14 PM
Jack Jack is offline
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Join Date: Jul 2009
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Default

Quote:
Originally Posted by tconner94 View Post
I had another thought on this topic. IF those surgeon fees are typical for fusion and my expenses are typical for single level ADR, where is the incentive for a surgeon to go to the trouble of learning the new technique and using it where appropriate? I know that it's all supposed to be in the best interest of the patient, but let's be honest, learning a new surgical technique takes time and money. If it will replace something you've been doing for many years and does so at less than 25% of what you receive while taking just as long to perform, who's going to adopt it?

I don't have the answers, just most of the questions.

And Jack, multivitamins usually contain 400 iu of vitamin D3. Just as an example, my physicians recommended 8,000 iu/day. Of course, I haven't seen sunshine here since November, and I was having a surprising number of unusual symptoms, so my dose was based on that. You can always get tested first to help with dosage.

-tc-
From my experience working for a thoracic & vascular surgeon new techniques where not that big a deal. It was mostly building on prior experiences and training. I would see, say an orthopedic surgeon getting speciality training by way of a fellowship to do spine surgery but never saw one once trained to get more than that offered in a CME conference for a new procedure. The powers in the hospital would not let them be turned loose without getting privileges from the hospital's attendings, and of course the fear of malpractice. Department heads held some power as well.

My thoughts are that the disparity between renumeration amongst MDs is way to large. Competition amongst practitioners is stifled by AMA politics. To a degree it is similar to what commercial pilots have and got so out of hand before the government stepped in and changed the way airlines were able to fly their routes. Pilots were paid by seniority number that had nothing to do with skill as long as they were able to get approved by an FAA designated check pilot. Pilot's unions sought more and more, as did mechanics, flight attendants and the airlines just past on the cost till the government stepped in to stimulate competition. Ditto to a lesser extent with Ma Bell.

Talk about a rant, how did I end up on the phone company.

tc, thanks for the info. Hopefully, I have made up by getting sunshine but I'll up my dose after a visit to the drug store. I'll need to check but think D is one of the fat soluble ones and can be overdone.

I've finished with the whiteout and plan on getting them to Harrison soon. Going over them really raised new questions. For instance, nobody said anything about blood but it seems from the bill I was charged for two unit.
__________________
Suffered thru every non-surgical cure known without relief.
Pain management '06 to April '10,
Had minimally invasive PLIF with internal fixation on 12/28/09 for isthmic spondylolisthesis of L5-S1 (TDR contra-indicated) DDD at L3-4 & L4-5, All L-Spine doing well. Episodes of no pain at all. After being relatively pain free for 4 months, C-Spine gave up. MRI due 11-1

Last edited by Jack; 03-01-2010 at 10:39 PM. Reason: spelling
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  #10  
Old 03-02-2010, 01:27 AM
2cool4U 2cool4U is offline
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Posts: 141
Default Not much risk of Vit D overdose

Current thinking on vitamin D replacement suggests that very high doses are easily tolerated. The risk of overdose is minimal. I was also taught that it is lumped in with the fat-soluble vitamins. However, it actually functions more like a hormone. Most articles suggest an upper limit of 10,000 iu/day, but even then admit that higher doses have been given to patients without complications. The body uses about 10,000 iu/day in its normal processes, so you either have to get sunshine or replace it somehow.

The numbers on who is at risk and who would benefit from replacement are staggering in the medical literature. I'm seeing 60% of the US population and up to 93% of those over 60 are found to have some degree of hypovitaminosis when serum levels are tested. Of course, not everyone will be symptomatic, but since the symptoms are so non-specific, who knows what improvements might be possible in these at-risk populations.

There are many resources, but start at www.vitamindcouncil.org
Also, go on Medscape or PubMed to get some of the newer peer-reviewed stuff. It's not conclusive yet, but evidence is mounting.

Hope this helps.

-tc-
__________________
L5-S1 rupture 11/04, left leg pain for 2 wks
Regular exercise/pain-free until 2007
L5-S1 degen. disease w/constant pain since 6/07
PT, ESI, SI jt injections, 3-level nerve root inj. x 2
Massage, heat, ice, TENS, etc
L5-S1 Charite Jan. 19th, 2009, very happy w/decision
New back pain in upper back though.
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