Two Level ADR U.S. Pay out of Pocket

[drewrad]

Drewrad: $50,000, 3 level hybrid, L3/4/5 M6L, L5/S1 fusion. Clavel.

[JeffR]

Colorado Babe's surgery cost was ~132K not ~26K. The ~26K was just the amount that insurance covered.

[Cynlite]

My understanding is that the hospitals charge an inflated amount knowing what is the allowable amount. They then write off the difference as a loss. Colorado Babe did not have to pay the difference so, the inflated amount is just air for tax purposes the way I see it. If I'm wrong, I'm happy to make the changes on my spreadsheet but, I'll leave it the way it is for now. Thanks for your input on this Jeff. I appreciate everyone's input. I'm doing this exercise to help others so they don't have to look so hard to find the data we all worked hard to get.

Thanks drewrad. I've added your information!

[JeffR]

Honestly a hybrid procedure out of pocket is definitely over 100K in the US. I was quoted 125K for a hybrid with two prodiscs from TBI and they tried hard to get the price down - and that was 3 1/2 years ago.

The amount insurance covers is NOT what colorado babe ended up having to pay, i.e. if insurance covered 26K and the procedure was 132K then she had to pay 106K out of pocket. Putting the price down as 26K on your sheet is misleading since no one is going to pay that amount for that procedure even with insurance (it is just what the insurance company was willing to cover).

[Cynlite]

Jeff, I sent Colorado Babe a message to see if she can clear this up for us.

[colorado babe]

I had a two level Mobi C at cervical and a fusion at L5-S1!

[colorado babe]

Originally Posted by JeffR

Honestly a hybrid procedure out of pocket is definitely over 100K in the US. I was quoted 125K for a hybrid with two prodiscs from TBI and they tried hard to get the price down - and that was 3 1/2 years ago.

The amount insurance covers is NOT what colorado babe ended up having to pay, i.e. if insurance covered 26K and the procedure was 132K then she had to pay 106K out of pocket. Putting the price down as 26K on your sheet is misleading since no one is going to pay that amount for that procedure even with insurance (it is just what the insurance company was willing to cover).

The amount Insurance paid on the spreadsheet is correct. I only paid $25.00 Jeff.

[JeffR]

Originally Posted by colorado babe

The amount is correct. I only paid $25.00 Jeff.

$25.00 is pretty cheap. :P

Is the $25K what YOU paid our of pocket (and insurance paid the rest), or what the insurance company paid on your behalf (and it cost you nothing)? You said earlier it was the amount paid by insurance which is why I was/am confused...

[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?

[colorado babe]

Originally Posted by JeffR

$25.00 is pretty cheap. :P

Is the $25K what YOU paid our of pocket (and insurance paid the rest), or what the insurance company paid on your behalf (and it cost you nothing)? You said earlier it was the amount paid by insurance which is why I was/am confused...

Insurance paid it Jeff. My share was $25.00. Not sure why you are confused.