$$$$: How much AVR costs??

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taranjit

I will be undergoing AVR in the near future and would like to make sure that I have arranged enough money to pay for the surgery... Currently, my employer has the following 3 medical insurance options available:

(i) PPO: Blue Cross of California (I pay 20%, insurance pays 80%)
(i) HMO: Blue Cross of California (I pay 10%, insurance pays 90%)
(iii) Kaiser: I believe everything is free..

Question#1: I currently have (i), i.e. PPO.... It gives me freedom to go and see any doctor or surgeon, while HMO will probably restrict that... I know nothing about Kaiser... Which ones of these 3 should I have in order to mininize my surgery costs... We are having an open enrollment soon in our company so I thought I will check with you more knowledgeable folks...

Question#2: How much does it cost (approximately) for a general AVR? For catherization?? just a very rough estimate so that I can find out for myself if I can afford it or not, even 20% of it... I have been paying about $150-$200 every time I go for echo which is 20% of the total cost...

Question#3: any supplemental insurance I should buy?? to offset some of that 20%??

Question#4: I am a Canadian Citizen although I have been away from Canada for a while and currently not covered under their insurance... but if it makes sense, I can consider going back, get insurance again and get operated there.... It probably is free there...


Question#5: I live in San Francisco/Bay area, California.... Please send me information on good surgeons in this area - (a) R.P., (b) mechanical valve, (c) other valves... Is Stanford #1 in this area?? any other hospital or surgeon you would recomment? I can even use a new cardiologist...

if possible please provide me info.. I do not know much about how medical insurance works.. anything and everything will help...
thanks
taranjit
 
You ask a difficult set of questions. The best I can say is that you don't want to pay any of it if you can help it. My AVR was done in July and I had complications which I ended up in the hospital for 60 days. My hospitalization alone was almost $169,000.

My catheterization was almost $4000.00 all included.

I can't tell you which or what insurance company to use. That's the hard one. Kaiser would be my choice only because my past experiences with Blue Cross included them doing everything possible to not pay claims.

Valve selection is unique also. I would start reading threads and see what others have to say. For me, I went with a St. Jude Mechanical because this was my second surgery and I don't want to have another, though there is no guarantee that I may not have to. In general, mechanical valves last a lifetime.

I'm going to let others answer some of these.

Welcome to the family! There are lots of resources here, so look around, read around, and ask questions.

:)
 
Personally, I would not choose Kaiser for any open heart surgery.
That said, I would go with the plan that lets you pick the best surgeon you can and pay the most for it. Are you sure the hospital isn't covered totally? I have Prudent Buyer Plan and my Avr was covered as well as all the tests, etc.
However, for my 1st AVR I chose a non contracting surgeon and ended up having to get a loan to pay what I owed for his bills, the anethesiologist, and some other charges. I believe the charges for my last Avr were around $60,000. All covered, thank goodness.
Gail
 
Cha-Ching!

Cha-Ching!

My final tote board for 15 days hospital, ICU (8 days of it), 2 St. Jude valves, surgeon / anesthetist / radiologist / catheterization fees came in at $156,000. My company provides excellent insurance, so I was out $0. I realize I am extremely lucky there.

Unfortunately, I know nothing about any of the carriers you mention from direct experience, but I have heard Kaiser "jokes" and my Blue Cross experience in another state was not a happy one.
 
costs

costs

It sounds as if you are close to your surgery date...with that in mind I'd suggest not bouncing around with your insurance. They may find it a reason not to cover it. Stay were you are. Even if you have to come up with 20%. There are public services you may use...like "state papers". Contact your hospital and schedule an appointment(now) with one of its social workers. They can be a great help getting the paperwork filled out ect. That is one of many reasons to make friends with them.

My AVR cost was about $170,000. The cath was about $3000.
 
Hi!
I don't know my exact total yet, the bills are still coming in. I was bounced from one hospital to another, so I will give you approx totals from the hospital that did my surgery.
Cleveland Clinic Foundation
Hospital stay approx $63,000
Aortic Valve Replacement approx. $15,000 ( I also had anuerysm repair that cost an addition $7,000)
Anesthesia approx $6,000
I know there are more bills lurking out there for me.
I had a CT scan done as well as an echo, plus tons of bloodwork etc.. I'm not quite sure what those costs are yet. I'm sure I will easily hit $100,000 or more. My plan is an 80/20 plan. I had already hit my out of pocket maximum earlier in the year when I had a c-sect. So, they should pay 100% of my bills. I am having some problems with the insurance company stating that the costs are above and beyond the reasonable amount for that area (don't they all say that). I am also having a little bit of trouble with my insurance wanting to pay the anesthesiologist bill. I am still working on it. I have managed so far to get them to pay for things they were not originally going to, so I hope I won't end up paying anything.
I can't really recommend any particular insurance company or plan. Just get the best medical care you can. Good Luck with everything.

Take Care!
Gail
 
Have yet to see any bills for my AVR. I paid 150 dollars to get in the hospital. The HMO paid the rest. I am waiting for copies of the bills to show up.

The Cath was $5700 for the hospital lab. Don't know what the cardiologist charged for his part but his office visit is $307 so I guess $1000 to $1500 for sticking the cath in.

I don't agree that changing plans would cause a problem. Most states if you are covered and change plans there is no "pre-existing condition" exception. Just don't have any lapse in coverage.

Check with your present carrier about "stop loss" coverage. Many require co-pay but have a maximum per person and per family "out of pocket" amount where the insurance steps up and picks up everything above that point. Thus, limiting your cost on most procedures. Talk with the customer service people at your carrier. They will give you the straight scoop-or at least should.

Good luck.
 
Taranjit,

I second the recommendations to investigate a Maximum Out of Pocket clause with your present BCBS PPO. That is typical BCBS coverage, at least in my state. The exact limit depends on the coverage you select and size of your family but should have a limit in the low 1000's of dollars.

I like the BCBS PPO plan, just make sure your Doctors and Hospital are participating providers and everything is approved. You may want to contact BCBS beforehand just to be safe.

'AL'
 
I think my Ross Procedure was around $50,000.
I had 4.5 days in the hospital.
My Aetna insurance picked it all up except for $200! I got a deal.
I feel lucky.
Most of the cost was the cost of the operating room and stuff, not the surgeon's fee.
 
There's an important consideration with BC-BS PPO coverage that I have not seen mentioned so far. BC-BS limits payments to a schedule of "usual and reasonable" charges. PPO participants are bound to accept these limits but others are not. Thus, the freedom to choose any physician or hospital comes with financial constraints. As an example, my basic hospital bill for surgery was about $64K but the BC-BS allowance was just over $29K. If the hospital had not been a PPO participant, I would have been responsible for the difference. Similarly, the bill from the surgeon was $14K but the allowance was just $3,860. Fortunately for me, everyone involved was PPO.

It's very important to know if your hospital and physicians are PPO participants! If they are not, you might try negotiating for acceptance of the PPO limits. I have friends who tell me they have sometimes had success with this.

As far as changing plans is concerned, unless your employer has an open enrollment period now, it may not be practical to make the change. Same issue applies to supplemental insurance. Except for some open enrollment periods, you won't be able to get coverage for a pre-existing condition without a significant time delay.
 
Roy makes a good point.
My Aetna was a PPO and my surgeon, anesthesiologist and hospital were all in the PPO. My cardiologist was not, so all my pre-op stuff done by his office was out-of-pocket from me.
Now, I have new insurance thru my husband's employer and everyone is on that plan! Finally.
 
Hi,

I am also in the Bay area. I have Blue Shield PPO and it paid for everything. I work for the hospital so maybe my plan is better?? My Cardiac Group is the S.F - Peninsula Cadiovascular Medical Grp....the are contracted with B/S. My Doc is Dr Colman Ryan. My surgeon was Dr Alex Zapolanski.

I would say 'ball-park' $$$200,000.00. I had AVR and CABGx2 at Seton Medical Center in 1998. My husband had a Quad CABG in 2001..same Doc's and hospital. B/S paid for all (allowable..per contract). In my book my Doc's are superb!! So many excellent Doc's in this Bay area...Kaiser used to send their Heart Patients to Seton...don't know about now. The S.F. Heart Institute is quite large and talented. You might want to check them out..My Doc's are top of the line with ALL those initials...M.D/F.R.C.P/F.A.C.P/F.A.H.A...I hear Stanford is excellent also.

Hmm..you got some homework to do! Best of luck to you.

Zipper *~*
 
P.S.

P.S.

Forgot to mention..MANY of the Doc's are jumping OUT of the HMO's...Very important to check out their status for now and future care.

Zip *~*
 
$$$$

$$$$

I was glad to see Mara posting her surgery bill, because I was thinking I was really pumpheading seeing everyone's bills over #100,000. My total bill for everything at the Cleveland Clinic was around $68,000. My home cardio and expenses here were extra, but not that bad...maybe $4-500 that insurance did not pay. I have MESA/Blue Cross...being Michigan Education Blue Cross.
 
Forgot to mention..MANY of the Doc's are jumping OUT of the HMO's...Very important to check out their status for now and future care.
Click to expand...
Stop it Zipper! Your going to curse me and then I'm going to have some problems. ;)

...And about Kaiser-I have had no experience with them, but I have BCBS and it wasn't a pleasant one. I know there all different from state to state, so maybe I got a bad apple in the bunch.
 
Last edited:
no cursing..lol

no cursing..lol

Hi Ross..I would never curse you! ;-)

My policy is not BCBS...It is Blue Shield of California..PPO. My Cardio and associates/also my Endo and Ortho are not renewing their contracts with HMO's. Here in California the Doc's have had major problems getting re-imbursed from Blue Cross HMO's.

As to the 'ball-park' on costs of surgery..In this I include all costs..the cath, the doctor fees, surgeon fees, other consulting Doc's..(Pulmonary for example),hospital charges, etc. It may be higher here..(most things are). As long as I go to any of the preferred Doc's and hospitals in my PPO (very large selection), I do not pay anything other than a small office visit co-pay.

Maybe I've got exceptionally good coverage..whew..sure glad!!!! I just had a Nuclear (gated SPECT) stress test and did not have to pay anything. Also had an Ultrasound Fine Needle Biopsy on my thyroid...again...totally covered. All RX's require a small co-pay.

Well..I'll hang onto this policy even tho it will be very costly (about $300.00 a month) now that I'll be going to COBRA, since I've been off work on temporary workmans comp..(they pay for everything too).....

Sorry to hear of the woes of those that have had problems with insurance companies paying. I guess I'm lucky in this regard!

Zipper *~*
 
The bill for my AVR, which included a catherization the day before and five nights in the hospital was about $70,000.
At the time I had Aetna HMO and my total out-of-pocket cost was $500. No complaints at all about Aetna - their people were very helpful anytime I had a question and they paid all the bills quickly.

Mark
 
Cheap valve replacement!

Cheap valve replacement!

Had St.Jude mechanical mitral valve replacement 4 years ago at Inova Fairfax 10 miles from my house with good parking. Total hospital bill ( I was out AM 4th day), $29,500, surgeons fee $5000. No wonder these insurance companies go nuts trying to figure how much hospitalization and surgery is worth!
 
2 Valves, Bovine Patch, 3 Bypass, Many Complications. 16 days in Cleveland Clinic. $260,000. Medical Mutual. Our cost was less than $200.

No problems of any kind on the bill. Medical Mutual has office space at Cleveland Clinic. Their representative solves all problems at the site.

Advance PCS Drug Coverage--now that is another story!

Clicking and living in Western Ohio.

GO OHIO STATE!!!!!
 
Valve Job Cost

Valve Job Cost

Hi Taranjit,
Either I got the cheap economy job, or I don't know how to read my billings, or I did well. My surgery was in April of this year and the total billing approximated $50,000 -- and no billing problems -- at least not yet.
I tried real hard to have my surgery done while I still had private insurance and before I got on Medicare. That plan did not work out.
My catherization out-of-pocket cost back in June, 2000, while on the private insurance was, I felt, high.
My AVR while on Medicare was very reasonable. (Don't want to say too much; maybe all of the bills haven't caught up with me yet.)
I used to be so against anything that smacked of socialized insurance and so against anything performed by big government.
I remain a Republican, but Medicare has done well for me. When I call Medicare with questions I even get prompt, courteous and intelligent answers. As far as I'm concerned, Medicare is A-OK. (BCBS is the private portion of my insurance; I have what they call a carve-out plan for those who have Medicare as their primary insurance.)
I do not recommend turning 65 just for the insurance, but if it has to happen, Medicare is good.
Best wishes,
Don
 
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