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How much did your surgery cost?

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  • #16
    Originally posted by MitralMan
    In my case, my PPO is teling me that because I went out of network, my max out of pocket apparently doesn't count.
    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.
    Mitral Valve Repair 12/9/05 with Dr. Laks at UCLA.

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    • #17
      $160,000 - 15 days in UWMC, 8 of those in ICU on the ventilator, 2 mechanical valves.
      25 mm Aortic & 29 mm Mitral St. Jude Master Series Mechanicals - UWMC 4/16/2002
      Guidant Insignia Pacemaker - Virginia Mason Medical Center 5/19/2005
      Cardioversion Tote Board: 3

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      • #18
        Originally posted by MitralMan
        In my case, my PPO is teling me that because I went out of network, my max out of pocket apparently doesn't count.

        Would have been nice if they'd explained that to me beforehand...
        did you talk to the insurance company before your surgery? Justin had a few surgeries out of network (we have blue cross ppo) and always got them cleared before the surgery, sometimes it took a few phones calls, but they always eventually coverred it, like it was in netwrk, lyn
        Lyn
        Mom to Justin 25 TGA,VSDs, pulmonary atresia/stenosis ect, post/Rastelli, 5 OHS, pacer in and out ... and surgery w/muscle flap for post op infection (sternal osteomyelitis with mediastinitis) [url]www.caringbridge.org/nj/justinw[/url]

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        • #19
          Hospital costs

          My hospitalisation with endocarditis and latter hospitalisation for AVR were both done on the national health system (Medicare) my total out of pocket was AUD$18 for the surgeons consult before surgery, this is because that?s the fee he charges above the amount Medicare covers for this item. In a private hospital in Melbourne for an uncomplicated OHS I believe it costs about AUD$60k (USD$45k). Even with private health insurance you can end up thousands out of pocket, this is because there is no cap on the maximum out of pocket. One thing that surprises me is the haggling over the bill that goes on in the US and it always appears to be post surgery, is there a reason why it isn't negotiated presurgery before you have incurred the bill?
          OldManEmu

          "The only thing we have to fear is fear itself." FDR

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          • #20
            Yup, everything pre-cleared. Doctor's office handled the paperwork, though.

            Originally posted by Lynlw
            did you talk to the insurance company before your surgery? Justin had a few surgeries out of network (we have blue cross ppo) and always got them cleared before the surgery, sometimes it took a few phones calls, but they always eventually coverred it, like it was in netwrk, lyn
            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?

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            • #21
              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 :p

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              • #22
                Originally posted by MitralMan
                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.

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                • #23
                  Gina, the key phrase is "usual and customary"

                  Originally posted by geebee
                  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.

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                  • #24
                    I was told the same thing, Mike.

                    Originally posted by MikeHeim
                    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.

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                    • #25
                      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.

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                      • #26
                        My surgeon's fee was 5,286.01 USD, then the other doctors charged on top of that.
                        Lithotripsy for kidney stones 8 December 2004.
                        Began to feel unwell 19 December 2004, with hindsight, the beginning of endocarditis.
                        Stroke 12 March 2005.
                        Endocarditis diagnosed 16 March 2005.
                        MVR/AVR - ATS 30 June 2005.
                        Discharged 10 July 2005, taken ill on journey from hospital.
                        Admitted to hospital 14 July 2005, complete heart block.
                        Discharged from hospital 22 July 2005.
                        Returned to work 9am on 7 November, dismissed 9am 7 November 2005.

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                        • #27
                          Originally posted by MitralMan
                          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.
                          Mitral Valve Repair, 07/2005, NYU Med. Ctr.

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                          • #28
                            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.

                            Comment


                            • #29
                              nearyneary, that's eye-opening.

                              Originally posted by nearyneary
                              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.

                              Comment


                              • #30
                                Bouteloa, I asked Independence Blue Cross in advance...

                                Originally posted by bouteloa
                                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!

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