Nailing down a US hospital on cost of surgery...

[laid up doc]

So as part of my ADR vs fusion decision making... trying to get a quote for what I would have to pay out of pocket to get a MIS-TLIF here in NC.

The surgeon's office was very helpful and gave me 8 cpt codes to give to the hospital and anesthesia folks.

What I know so far is that the surgeon/assistant fee alone is about 30k. They give a 30% discount for self pay so ~$20k.

So while typing this, the hospital called me back about the cost of those cpt codes at the OR/hospital level. She said at least $80-90k. Even w/ a huge self-pay discount... this is waayyyyy more expensive than an overseas ADR (or fusion for that matter)

And I haven't even heard back from the anesthesia group.

So... praying that I'm not allergic to titanium/aluminum/vanadium and I can go to Spain in a few weeks.

[Jstuckey]

Good luck on the test results. You will do great in Spain.
After my $9000 outpatient, diagnostic test (discogram) - I didn't even bother to ask what the costs would be for invasive spinal surgery!

[herron65]

I am with joey sue, the price difference between the USA and Spain is not even close, and the care is just as good as here and the rooms a huge. The food is ok as long as they don't put you on the no salt diet. That was sooooo gross. You will come out ahead going to Spain and get to see a beautiful city at the same time.
Take the bus tours they go every place
Good luck to both of you
Jeff

[annapurna]

Another thing to watch for on self-pay at a US hospital: some states do not restrict the hospital's ability to come after a self-pay patient for more than the pre-adjusted fees they'd charge a insurance patient. Depending on the state, it can be legal to take a procedure that would be nominally $100k for an insurance patient, which would be discounted by the insurance to some fraction of the $100k, and charge more than $100k for a self-pay patient.

[nanfromsactown]

This is very useful information, and while I haven't checked in my state of California, I'm sure the numbers are similar.

I have recently become self pay for my back injury due to settling my work Comp case. My attorney was sure I would be paying $.50 on the dollar for my treatment since The docs would no longer have to dictate reports and in general it would be less of a pain to have me as a patient.

But not so! My first visit back to my pain doc was going to cost $150, which is their "cash pay" amount for a basic office visit. When I told them my settlement states I am to pay the work comp fee schedule amount, the price went down to $89 with an additional "report" fee of $12, for the dictation they need to put into their file. Then this week I was referred for an epidural, and the first quote was $915, which then dropped to $650. I am a bit upset about my conversation with the scheduler because when she first called me with the $915 figure, I asked her if that was the work comp fee schedule amount and she lied to me and said yes. Then she called me back and back peddled.

The whole thing is wrong for many reasons, that insurance companies get to negotiate the costs down and then the cash pay patients are being forced to pay much more. I know the system needs to change but I don't know how to change it. It's frustrating.

I'll get off my soapbox!

[Harrison]

Nan, no need to get off the soapbox -- the system is fried for so many reasons.

AnnaPurna, thanks for that keen observation. But it seems unfortunate that states have this latitude -- it's confusing and IMHO, completely victimizing.

Jeff, what's wrong with a no-salt diet? Jeez?! Bring your healthy, zesty non-salt spices when you travel.

[laid up doc]

i'm going to call the hospital again next week to get some of this in writing - i'll need it for my Aetna appeal - and really press them about the self-pay issue.

my understanding is that i am in a state where they are not allowed to gauge self-pay pts.

the surgeon's fee alone would be $20k, AFTER a 30% self-pay discount. the hospital costs they told me at least $80-100k. i was so disheartened i just got off the phone - and didn't even get the anesthesia quote. too depressing... like i said i do have to get some of this in writing, but will work on positive activities first like deciding for sure on Boeree vs Clavel and booking everything.

[fl man]

Hello,

I just went through what you are. My BCBS denied my pre-certification for several non reason. I arranged to self pay. $32,200 is what I paid. Had surgery 5/31/2011 at c5/c6 and all went great. I submitted my bills for reimbursement. They are now starting to pay after getting my records and bills resubmitted. I expect to get back 80% of the 32,000.

The hospital ledger of my surgery came in at 79,000. I am not sure if it included my Dr. or the anastelogist. my cash payment break down was 15k for my doctor, 14k for the hospital, 3200 for the anastelogist. My Dr. and anastelogist both submitted bills for me and I will get repaid by them. The hospital would not do that. When I asked the hospital for a zero balance statement showing proof complete payment, they gave me a letter stating that I have satified the patient responsibility for this surgery. Not the same as I paid everything they asked for.

This is how it went when I had my first adr in 2004 at l5/SI. I was part of the study group and got the Charte disc thrown in for free. I paid 25,000 then and was promply reimbursed United health when they verrified what took place.

If you can afford to pay and float bill for 90 to 120 days you should be ok. I went in with the attitude that it did not matter if I did not get any reimbusement. My health and quality of life was worth it.

I am sorry for everyone who is not in a position to work it this way. The ins. industry is playing games with your health. I now believe that it is not a matter of a new method that is better then fusion, but a matter of the whole system getting the most money they can out of us. My wife is a medical coder and has been relating how fusions bills add up to 250,000 to 500,000. Why would any business let go of that cash stream for a 1 hour surgery that brings in well less then 100,000. Fusions patients are cash cows for everyone in the system.

Hope this helps

Pat

[laid up doc]

actually fl man... i was pricing fusion b/c Aetna won't pay for it for DDD.... ONLY US FDA approved ADR. i can't get a prodisc... would have at least seriously considered a fusion, but it's not even financially possible.

am fortunate that i can scrape together the money for an M6... looking forward to my trip and getting the next item in my "to do" list scratched off!!!