Valve Cost?

[Patrick7651]

Interesting. To clarify, was the $250k the original amount billed, or the amount paid? I'm guessing they billed alot more and got paid $250k. What valve did you get? Thx.

The $250,000 was the amount billed. The actual amount insurance paid was less, but I’m not sure how much less. My valve was an On-X.

 

[RAS]

A timely article from WSJ 2/11 on hospital insurance negotiated contract prices for 4 different procedures. One of which was "Major heart procedure with complex patient" It does not describe the specific procedure. They did their analysis using data from Sutter Health in Modesto, CA. The insurance plan is the only variable.

To be clear - the comparison is the contract price for the same procedure within one specific health system across different insurers.

Here is a summary of the heart procedure comparison: (derived from a graph in the article)
Medicare

7 Medicare insurers: Each charge $89,752​

1 Medicare insurer: $100,000​

Sutter Health Plus HMO: $200,000​

Commercial

4 insurers In-Network: Between $205,000 and $225,000 (I'm guessing based on the position on a graph, since tick marks are at 100k increments and only a few specific amounts identified )​

2 insurers in-Network: at about $250,000​

3 insurers in-Network: between $270,000 and $300,000​

1 insurer in-Network: about $350,000​

1 insurer in-Network: about $410,000​

1 insurer in-Network: about $425,945 (this is the max for in-network)​

​

1 insurer out of-Network: about $440,000​

2 insurers out of-Network: between $495,000 and $505,000​

3 insurers out of-Network: $515,697​

​

Sutter uninsured "discounted" cash price:

For those who pay out of their own pocket: $325.703 (they noted that most uninsured patients qualify for charity)​

​

​

​

The hospital system probably has no idea what these procedures actually cost. Their pricing is a matter of how they negotiate with each insurer to reach desired margins, how they perceive the value of each insurer to their medical system, and what the insurer's focus/goals are for managing costs for their particular mix of patients. It will be interesting to see if the requirement to reveal these negotiated rates will have a positive impact going forward.

​

​

 

[Keithl]

I believe my amount billed was around $250K, but paid was something like $60K, rather said statement on the cost of medical and the need for having insurance coverage.

 

[tom in MO]

I have a friend who's rich and only has major medical. He pays cash and gets somewhere around 50% discount on the full amount.

 

[Chuck C]

"As I recall the valve was a couple hundred dollars......."
Amazing! I've paid more for irrigation valves at the hardware store! lol

 

[Keithl]

I was pulling up some old bills, and the surgeon billed $36,265 and insurance allowed $9,761.50