How much did your surgery cost?

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MitralMan

I'm not sure if this is the right place to start this thread, but I am really curious. I'm still in discussion with my insurance company -- 17 months post-op -- over reimbursement. Seems to me that "usual and customary" is a a giant loophole.

How much were your surgeon's fees (excluding hospitalization, anesthesia, cardiologist's fees, etc)?

Mine was originally $30,000 for a minimally invasive mitral valve repair, still being negotiated.

Thanks in advance!

MM
 
Mine was a $100K for a mitral repair, three nights in the hospital, plus three additional nights for a readmission. All the tests leading up to my surgery used up my out-of-pocket maximum for 2005, so I didn't have to pay a penny.

If I remember correctly, the actual "Operating Room Expenses" came to about $38K. Of course, I was at UCLA, and EVERYTHING is more expensive out here. :)
 
My spendy trip over the mountain

My spendy trip over the mountain

My hospital bill came to about $93,000. I was in for 10 days. The surgeon's fee was about an additional $10,000. 5 hour surgery....$2,000 an hour!:eek: My insurance negotiated the hospital payment down to about $34,000. I don't know what Dr. Starr ended up receiving. I'm on a Medicare "Advantage" plan, through Regence Blue Cross. I think that's why the hospital had to accept MUCH less than they asked for. My out of pocket co-pay was $800.
 
I didn't ever try to break stuff down, but the total amount started out just over $150K. That included a new SJM aortic valve, operation, 6 day stay in hospital and the surgical team. BCBS got total price reduced to just under $100K.
greg
 
Wow, sounds like my 45,000 ukp (83,000 usd) was a relative bargain for an MVR, nearly a week in ICU/HDU and a total of over six weeks in hospital on expensive antibiotics. Of course it would have been even cheaper (more or less "free") in a public hospital under our National Health Service, although nowhere near as tolerable...
I guess this highlights to some extent the differences between US and UK medical charging.
However, I do pay some 2,300 usd annually in private medical insurance (it was much cheaper till I hit 55, but with my claims history I've got nowhere else to go). I've no idea how that compares with US health insurance costs.
 
My first was $223,000 which was an emergency and I was hospitalized for a month and half. My second came to $110,000 and I was hospitalized for 2 months.

Insurance companies only pay between 50 and 65% of the billed amount from the hospital. If your being asked to pay a large portion, I suggest you call their billing department and negotiate a settlement. Whatever is left over is negotiable, but they won't tell you that.
 
My last surgery was $87K and I believe the surgeon's fee was $17K. Of course that was 12 years ago and I wouldn't even know how to transpose that into today's numbers.
I paid $1000 out of pocket which was the plan max. If you are working in network and have a max out of pocket, "usual and customary" should not factor in. If you are in network, whatever the "deal" the insurance company and the hospital/doctors have worked out is what is paid. If you are out of network other things might come into play.
If you are working in network, do not let anyone bully you into paying more that your plan max for out of pocket (unless your plan does not have a max out of pocket but that would be rare).
Best of luck.
 
My AVR was around 60-70k.
I think the valve was billed as "prothestics" and was around 4-5k.
 
$$$

$$$

I just got my bill for my ross, the operation was $8000. That did not include the hospitalization, anesthesia, or cardiologist's fees, I can hardley hold in the excitement for that bill!!!:D

I had mine at Baptist Hospital Knoxville, Tn
 
My double valve replacement, including an angiogram just before, cost £27,274.78 which is about 50,687.97 USD. That included everything, eleven days in hospital, surgeon, other doctors, a couple of ATS valves etc.

On top of that was my stay in another hospital with endocarditis, I haven't worked out what that cost, three weeks were in a private wing, then I was flown to England in a chartered 'plane at no cost to me or the insurance company, our taxpayers paid! I did get a bill for the ambulance to the airport, the insurance paid part of it and the other part I threw at the hospital for them to pay. :) The hospital I was taken to in England was free on the NHS.

Last year the premium for my health insuance was £1,529.00 which is about 2,842.47 USD. I had a scary moment, my insurance was up for renewal on 28th June, I had to fly to England on 29th June for surgery on 30th! BUPA wouldn't give me authorisation for the surgery until 29th when they had received payment - that raised the pulse until they confirmed receipt at 8.30am and said I could go ahead. :)
 
Well thank goodness for the NHS is all I can say cos I bet Clo has totalled up some money after 3 open hearts, a cardiac cath, numerous weeks in PICU and hospital wards, massive doses of anti-biotics, a lumbar puncture (suspected menegitis) not to mention her On-X valve! I dread to think how much it would have all cost - and she got excellent care too.

Emma
xxx
 
When everything was said and done, my total billings for my mitral valve replacement came to $96,000. With double coverage by two different insurance companies, Primara and Regence, all bills were paid by the end of the 8th week post-op. Total charges paid by me, $0.
 
Thanks, everyone. Keep those cards and letters coming!

Thanks, everyone. Keep those cards and letters coming!

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...
 
MitralMan said:
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.
 
MitralMan said:
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
 
Hospital costs

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? :)
 
Yup, everything pre-cleared. Doctor's office handled the paperwork, though.

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

Lynlw said:
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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