The bottom line: cost of surgery and hospitalization

[MitralMan]

I actually have no idea how much a valve repair is going to cost. I have Independence Blue Cross and have been pre-certified, but they'll only pay 60%. 40% of anything is significant, but how significant? If this is going to cost $100K, I simply do not have $40K sitting in a bank account -- nor under my mattress.

Is it possible to negotiate with either the insurance company or the hospital/doctor?

Thanks in advance

 

[bvdr]

You most certainly can negotiate with the hospital. A friend of mine recently did just that. You will have to also do it with the different doctor's involved. Prices of things are very inflated since insurance companies only pay a percentage of the total bill anyway. Go for it!

 

[MitralMan]

Thanks, Betty.

Thanks, Betty.

Any suggestions for how to approach?

 

[Ross]

You can negotiate with the hospital, but I'd file so many appeals with the insurance company that they'd beg to pay it to shut me up. By nature, they do their very best to pay as little as possible and even weasel out of things that are legitimately their responsiblility to pay to start with. They typically only pay roughly 1/2-2/3 of the billed amount, so don't fall for the game of feeling responsible for the rest. Become a real pain in there sides.

First thing, when you feel up to it that is, is to get a itemized copy of your bill for everything and everyday. You'll find all sorts of mistakes and most likely even some bogus charges on it. Make the hospital answer everything that you question. A lot of the nonsense will get eliminated here which will leave the raw amount for the insurer to cover.

What ever you do, don't take what you get at face value. Question everything and everyone.

 

[Marty]

There is great variation in the cost for a mitral valve replacement or repair depending on where you go. A friend had a repair at Cleveland Clinic the top rated hospital in the world for mitral surgery and his total cost came out to just over 70K in 1998. I chose to have my operation at my own county hospital, Inova Fairfax, and my total bill including all surgeons fees was 30K. I had no complications and went home the AM of the fourth post op day. Complications would have taken the bill up. So it won't hurt to shop around a bit. I'm joking now but did you read about the carpenter from North Carolina who went to India for his surgery? Travel, aortic valve replacement, and tour of Taj Mahal for about 10K!

 

[Guest]

Warning: Do NOT negotiate with the hospital pre-surgery.

Er, at least that was the lesson I learned.

The day I went in for my pre-op stuff (the Friday before the Monday surgery), the hospital _insisted_ that I discuss with them about payment and actually had me sign an agreement on how much I would pay them per month beginning (iirc) in March of that year.

Except, they neglected to tell me that different services would be billed separate from THEIR bill.

What happened?

I started receiving bills that, when I called the hospital to "call them" on the agreement THEY made me sign, they indicated that those bills were, indeed, not from them.

I then advised them to null the agreement I had signed because, obviously, I would not be paying them all of that dinero.

Basically, since different aspects (i.e. anesthesia) billed my insurance company before the hospital billed their charges, I was responsible for charges for my part according to "first come, first served" scenario. So, instead of owing the hospital the certain percentage of the entire bill for which I was responsible, I owed some of that percentage to the other areas that billed first.

Took a bit to straighten out (along with some very strenuous phone calls to not only the hospital accounting department, but also to my cardiologist and surgeons), but it was accomplished .

HTH,
Cort, "Mr MC" / "Mr Road Trip", 31swm/pig valve/pacemaker
'72/'6/'9/'81/'7, train/models = http://www.chevyasylum.com/cort/
MC Guide = http://www.chevyasylum.com/mcspotter/main.html

 

[Rich]

I have learned recently that Blue Cross and Medicare as well only pay out what is considered the national average for a procedure.
If you look at a Blue Cross statement for instance, it lists what the doctor charges, what the insurance pays, your deductible and then many times at the end the amount accepted.
So what they list as the cost of this may be very inflated.
They may well accept what the insurance pays them and you may only be responsible for your deductible.

 

[labguides]

Our daughter was told that her mitral valve repair (Jan, 2004 at UCLA) would cost about $180,00. I have no idea how much was actually submitted to insurance company. I really don't understand insurance -- I think that insurance companies make it complicated, so as to confuse patients.

 

[gijanet]

I guess this is a dumb question............

I guess this is a dumb question............

but do you have a maximum out of pocket expense? Ours is $6K............course that doesn't include the things that the insurance company won't cover or deems necessary (like the anesthesia doc was denied one time.........ayup, everyone can undergo open heart surgery without anesthesia............needless to say, we won that one!) I hope somewhere in the fine print you have a max. amount of out-of-pocket expense clause. Good luck. Hugs.

 

[epstns]

As mentioned, definitely read the fine print of your insurance policy. Many of the common policies have an "out-of-pocket maximum" that represents the maximum amount the insured (you) will have to pay in any one policy year. All amounts over the cap are paid in full by the insurance company.

Also, as noted, insurance companies only pay what is agreed upon in their contract with the hospitals. You are NOT responsible for any differences over the amounts that your policy considers "reasonable and customary" for the procedures done.

As patients, we have to remain fully aware of all this, lest we pay in our own cash what we've paid the insurance companies to cover.

 

[tommy]

My insurance company has negociated rates for everything. The list price for my AVR in 2000 was about 100k. The actualy price was about half of that. I paid about 5k.

 

[Marty]

I guess the answer is the insurance companies rule. This weekend we had lunch with a couple from Rockland County NY. He just had quintuple CABG. His insurance company would not let him have the surgery at Columbia-Prebyterian in Manhattan. He had his surgery in Hackensack NJ. It worked out well. The doctors were terrific and the nurses were beautiful and at age 76 he's back jogging and whitewater rafting.

 

[catwoman]

My surgery was $105,000-$110,000. I paid $100 co-pay to hospital. Insurance paid about $40,000, I think.
Next year's insurance coverage would have me paying more, but with a top payment of $2,000, I think.

My insurance coverage will **not** pay for a colonoscopy -- which UHC deems "unnecessary" because it's not diagnostic in their book (despite my own history of polyps and my mother and grandmother having had colon cancer). However, my GI doc said he **would** do it for what UHC would pay, not what he would bill out.

So perhaps you could get a hospital to accept you paying what the contracted rate is if it comes to that...

Just make sure pre-op that everyone is in network...

 

[Buzz Lanning]

Surgery Cost

Surgery Cost

I have copies of all the insurance bills associated with my aortic valve replacement surgery on July 6th. Here it is!

The total of ALL bills submitted to the insurance company in 2004 was $108,925. The total negotiated bill paid by the insurance company was $36,221. Note: Once the insurance company negotiates with the hospital / doctors, etc., this is the FINAL amount owed, at least with my insurance company.

Of the $36,221 agreed to by all parties, I paid $2,900. This included all tests, doctor fees, surgeon fees, hospital stay, protime tests, medicine, deductibles, etc. I should mention that the large discrepancy between the submitted & negotiated fees was primarily due to differences in the hospital stay; the hospital charged $73,000 for four days, the insurance company settled with the hospital for $15,000!

For me, I had no issues with insurance.