How much did your surgery cost?

[Tiffin]

My hospital bill was $212,000 16 total days in hospital (this includes the cost of valve and pacemaker unit)

My surgeons bill was $50,000.

For my two Cardio's doc's (one did testing and one did implanting of pacemaker) was $17,500.

Misc items brought total bill for all that was done to me $294,000.

And I haven't seen what cardiac rehab cost was yet since I just finished that up. So I most likely will go over $300,000.

What is a life worth? Its priceless and every day I thank those folks above for my new and improved life!

My pacemaker doctor and I laugh every time I get checked by him because he keeps saying in his beautiful accent from Eastern Europe "you pic a bery espenive disease to ave" I ask questions just to hear him speak

 

[geebee]

I'm guessing no one else has been in the position that their insurance company left them with a $30,000 surgeon's fee to pay?

This sounds totally "off" to me. If the insurance company paid on everything but the surgeon's fee, you should have some basis for a dispute. How can you have surgery without an expense for a surgeon (in or out of network)? Are they refusing the entire fee (I sure hope his fee wasn't more than $30K)? If it was then maybe you need a dispute with the surgeon.

 

[MitralMan]

Gina, the key phrase is "usual and customary"

Gina, the key phrase is "usual and customary"

This sounds totally "off" to me. If the insurance company paid on everything but the surgeon's fee, you should have some basis for a dispute. How can you have surgery without an expense for a surgeon (in or out of network)? Are they refusing the entire fee (I sure hope his fee wasn't more than $30K)? If it was then maybe you need a dispute with the surgeon.

The surgeon's fee was $30K.

As I understand it, Independence Blue Cross is telling me that the usual and customary surgeon's fee for mitral valve repair is less than $3,000; they're telling me that they'll only cover 60% of that (since it was an out of network surgeon, but that part I understood); and they're saying that my max out of pocket doesn't apply to out of network.

The insurance company apparently doesn't care that the surgeon is a pioneer in minimally invasive repair or that he does 100's of these procedures every year.

I am having discussions with the surgeon and the insurer. The surgeon has already shown some flexibility, but even so there's a ginormous difference between $3K and $30K.

 

[MitralMan]

I was told the same thing, Mike.

I was told the same thing, Mike.

That's interesting. My out-of-pocket maximum applied whether I was in-network or not. As I mentioned earlier, I had already reached that maximum, so it actually didn't matter where I got my surgery.

Let me put it differently: I wasn't told there was a difference when I spoke with them pre-surgery.

 

[geebee]

WOW - although I believe you, it is hard to conceive that any insurance company would think the U&C for a surgeon fee is only $3K. What world do they live in?
Do you have (or can you get) a copy of the actual policy? It would be interesting to actual see, in writing, that the max out of pocket does not apply to out of network.

 

[sue943]

My surgeon's fee was 5,286.01 USD, then the other doctors charged on top of that.

 

[nearyneary]

The surgeon's fee was $30K.

As I understand it, Independence Blue Cross is telling me that the usual and customary surgeon's fee for mitral valve repair is less than $3,000; they're telling me that they'll only cover 60% of that (since it was an out of network surgeon, but that part I understood); and they're saying that my max out of pocket doesn't apply to out of network.

MitralMan-- Your insurance company is completely out of line. I had the same surgery with the same surgeon for the same sticker price, and my insurance paid $26,311.52, even though it was out of network. I would definitely appeal. Good luck.

 

[bouteloa]

If you can, read the fine print of your health insurance

If you can, read the fine print of your health insurance

I am enrolled in an HMO. Like so many here, I wanted to go to the Cleveland Clinic for my mitral valve surgery but after reading the insurance and consulting with the HMO, they pretty much told me that if I wanted to go out of network, they would pay very little or nothing.

So I considered, literally, selling my farm to pay to go to Cleveland Clinic but wound up staying in network with a local surgeon, who turned out to be very skilled.

So I got a good surgery, kept the farm and my HMO paid the total cost of surgery. I had an intensive care coverage with AFLAC who paid me $1900 for my 5 day stay in the hospital.

So I wound up making money on the deal.

 

[MitralMan]

nearyneary, that's eye-opening.

nearyneary, that's eye-opening.

MitralMan-- Your insurance company is completely out of line. I had the same surgery with the same surgeon for the same sticker price, and my insurance paid $26,311.52, even though it was out of network. I would definitely appeal. Good luck.

I'm in the middle of the appeal process.

 

[MitralMan]

Bouteloa, I asked Independence Blue Cross in advance...

Bouteloa, I asked Independence Blue Cross in advance...

I am enrolled in an HMO. Like so many here, I wanted to go to the Cleveland Clinic for my mitral valve surgery but after reading the insurance and consulting with the HMO, they pretty much told me that if I wanted to go out of network, they would pay very little or nothing.

So I considered, literally, selling my farm to pay to go to Cleveland Clinic but wound up staying in network with a local surgeon, who turned out to be very skilled.

So I got a good surgery, kept the farm and my HMO paid the total cost of surgery. I had an intensive care coverage with AFLAC who paid me $1900 for my 5 day stay in the hospital.

So I wound up making money on the deal.

My doctors DID the paperwork. This is pretty fine fine print. But I take your point, and I'm delighted it worked out well for you!

 

[twinmaker]

Since it will be 25 years in August since my last OHS (mitral valve replacement), I guess the cost of my surgery would be a little outdated. It seems like I remember the whole thing costing around $35,000. That would include 10 days in the hospital and a couple of days in ICU. I don't remember what the surgeon charged. Just two years ago, I spent three nights in the hospital having my defibrillator implanted, and just the hospital portion was $40,000 for that. I guess everything's relative, right? LINDA

 

[mtkayak]

85k for everything - 3 days in the hopsital
Contracual price for BCBS was only 12k for everything!!!!!!!!!
10k for surgery
Surgery took 2.5 hours to complete = 4k per hour for surgeon
This suregon does 5 surgeries a day = 20k per day (ballpark figure) and he deserves every penny of it.
Insurance paid for private room because that is the only rooms they have available in that ward. Nice big room for my family

I hope they pay for my cardiac rehab

Feeling good = priceless!

 

[Jkm7]

I wouldn't want to be his 'fifth' surgery of the day. Eeeks........

 

[mtkayak]

Luckily he had just come back from vacation and I was the first surgery of the day

They way they set up surgery today (I'm guessing) is too prep everybody up beforehand. One surgeon opens you up, one operates on you and one closes you up. By the time the operating surgeon gets there you are ready to be operated on and of course he has his fellows to assist in surgey. I actaully got a bill from 3 different doctors.

A little off the topic here but if you get a chance read the book "Walk on Water, The Miracle of Saving Childrens Lives" The books deals more with children but you get an idea of what life in the OR is about. It's not pretty. The book takes place in Dr. Roger Mee's OR ( Cleveland Clinic) one of the top Heart Suregons in the world.

 

[Dave_40]

Geez, are you guys quoting the payed out or retail price.

Hospital alone was $200K payed at 23 cents ea for MV + bypass + icky complication reopen and 4 day ea ICU and ward. I have no idea what the surgeon got as I can't even figure out who paid him. Stupid multiple payer capitated billing.

St Jude retail price is $10K+
A T-echo will run $3-5K easy.

Now I liked rehab, but dont even get me started on cardiac rehab per visit charge, and get this it was paid at retail price. Crazy. For that kind of money they should have included a massage, a new work out outfit per week and a snack.

 

[mtkayak]

I'm quoting both. On my EOB the BCBS insurance was billed for 85K if you look at the section that states "Not Covered and "Covered". Under the section covered is what the insurance actually paid because of the contracted price they have with the Doctor or Hospital for that procedure. Under that section was 12k total. If I didn't have insurance the price for me would have been 85k. That's they way I understand it. I actually ended up paying $2200 total for everything. I have a $200 deductible and a $2000 maximum out of pocket. I met that easily after surgery. Everything is covered at 100% for the rest of the year excluding copays.

 

[Christian]

My wife's mitral valve repair at the Cleveland Clinic was just shy of $80,000. The "negotiated rate" secured by the insurance company was just shy of $50,000. And we paid $0.

 

[Brad]

Mine was free! Good ol' British NHS!

 

[Georgia]

MM - I understand that you get screwed by going out of network - we've have a few minor battles over this b/c the pcp's office fouled up the paperwork.

But how on earth have they determined the usual and customary surgeon's fee for a mv repair to be $3,000??? I've heard of insurers doing ballsy things, but this one's nuts. I'd go to the insurance department, make a complaint, and the insurer will have to justify the u&c amount to the dept. It won't cost you anything, and it'll annoy the heck out of your insurer.

And get a copy of your contract. See if it specifically says that the out of pocket doesn't apply to out of network. They figure they have you over a barrel because you're post surgery and they think you won't be in any condition to fight. At these costs it might behoove you to get a lawyer.

 

[sfconstrct]

sfconstrct cost

sfconstrct cost

haven't got the surgeon's bill yet, avr and root repair at Cedar Sanai, 174K four day stay. Bill said I owe 400 bucks wrote that check quick. Going on 9 weeks and all else is going well. Good luck. steve in so.ca.