VBG to DS Revision ?'s (Surgeon Decisions)

[Spiky Bugger]

I want to go on record re the craziness of the prices. I just don't know about the morality of people who will perform the surgery for FAR, FAR, FAR LESS when insurance pays and then essentially price gouge for self-pays.

I understand that insurance doesn't pay what it should and the surgeons have to pay staff and rent, but Jesus P. Christ...some of these seem a bit much.

Does anybody have a recent insurance EOB that tells how much a (stateside) surgeon accepts when insurance is paying?

I know my surgery was a loooong time ago, but I don't believe insurance pays surgeons anything near these +/- $30k prices they are demanding from self-pays...and it just strikes me as wrong...especially since the self-pays are cash in hand in advance and insurance companies dick around with payments, retroactively deny things they have already pre-approved and require more staff time for all the paperwork.

Grrrr.

 

[jillc]

@Spiky Bugger I agree, but since I'm Canadian, I don't have any idea what insurance pays. Some of these prices are all inclusive of hospital fees barring complications. But I also know from my parents, who live in Palm Springs in the winter have heard stories from their friends who have received a hospital bill and then they go and negotiate with the hospital for a better price.

We (my mother and I) were hypothesizing that perhaps the higher priced ones didn't negotiate a good price with the hospital? Or they deal through more expensive hospitals?

Of course this is all conjecture as I have little to no idea how the system works in the States. I do know that many times on the phone or in an email I had to repeat that I was self-pay and had no insurance. And sometimes, I had to say I was Canadian for them to understand that no insurance meant no insurance.

Does anyone know how these prices are set? I know with Keshishian, Greenbaum and a couple of others, the price was pre-set and included everything barring complications. But the others were ballparks (Rabkin $30-40K, which is a big difference).

 

[Elizabeth N.]

I can't compare for DS, but I know of the $19k I paid, surgeon fee was $3k. when former housemate had hers, medicare paid not quite $2k for the surgeon.

 

[Spiky Bugger]

@jillc Okay, I wasn't paying attention about the hospital being included. Color me bright wrong.

But that makes the hospitals the demons here.

@Elizabeth N. I think my surgeon received about that much from insurance. And he also had a "program fee." But the hospital wasn't hugely expensive and was mostly covered by insurance.

 

[jillc]

@Spiky Bugger @Elizabeth N. All the surgeons have been quoting (when the prices have been broken down) between $4-6.5 K for surgeon's fees.
Lutrzykowski was $6K, btw.

 

[Terri]

Pretty sure this was surgeon, or and everything for the surgery except maybe anesthesia. Hospital billed insurance around $90,000. Insurance paid $9,000ish. I paid $150 nutrition class fee and $120 for psych eval was only out of pocket expenses.

 

[jillc]

Holy carp fish! @Terri $90,000? That's not a typo is it?

 

[Terri]

Nope not at all. I think they charge so much knowing insurance is going to pay so little.

 

[jillc]

Okay, so, I'm a dunce when it comes to these things....I really don't understand the American medical insurance system. You're not on the hook for the remaining $81,000 then? From the sounds of it you only paid $270?

 

[brooklyngirl]

I only got schooled in this thing recently as I went through the approval process and I was totally confused by the explanation of benefits (EOB) letters, wondering why he crazy difference in what the doctors "charge" and what insurance pays. My sister does medical billing so she explained that they make their prices astronomical, knowing that some insurance companies will pay a lot, and some a little. When they say they "accept XYZ insurance" that means they agree to whatever that insurance company will pay them. So, for example, my old cardiologist tried to charge almost $20,000 for the nuclear stress test I had as part of the steps to get clearance. It was listed as different fees- the contrast, the medication to make your heart speed up, the machine you sit in to take more images (yeah, I know, I'm very scientific, lol) and the insurance company only payed something like $900 for the whole thing. With such a discrepancy I thought the dr was going to come after me for the rest, but since they had a contract with my insurance company, that's their agreement to accept THEIR prices. That's why if a doctor is out if network, you can still go to them and insurance will probably pay for a portion, but because it's not a contracted rate, they have to go back and forth about it and you might be on the hook for the rest.

Now, I don't quite understand why, with someone who is self-paying, they don't knock the price down. You would think, cash in the pocket is better than dealing with the insurance company. But maybe there's no guarantee that people will pay? I dunno, I think my surgeon's practice negotiates their prices based on your finances. Of course, I'm a little biased, but I think that's the best approach. I know everyone loves Dr. K, but I don't understand a $4,000 out of pocket program fee, that sounds insane to me. The original surgeon I consulted with had a $350 fee, the one who actually did my surgery had none. What exactly does this program fee cover?

Anyway, I'm rambling now, sorry for the incoherence!

 

[Terri]

Okay, so, I'm a dunce when it comes to these things....I really don't understand the American medical insurance system. You're not on the hook for the remaining $81,000 then? From the sounds of it you only paid $270?

Yes I only paid $270 out of pocket plus travel expenses for each trip, my surgeon was about 4 hours from me. But the rest is what Brooklyngirl said about how the doctor will accept what insurance pays.

 

[Spiky Bugger]

It all still sounds like a used car lot to me...

 

[jillc]

Thanks @Terri and @brooklyngirl for clearing that up for me. It just seems weird to me from the outside looking in.... It's like having a store and putting a $1,000,000 price tag on something and having a shill say "oh that's a bargain!" hoping someone will be gullible enough to agree. But oh well.
I don't understand why a lot of these surgeons don't just give me a fair price, as they're earning less with insurance. But oh well. I think Greenbaum is the only doc in the country that is charging comparable prices. I understand getting a bit more, but it feels like price gouging (or @Spiky Bugger's greasy used car lot salesman).

 

[brooklyngirl]

Thanks @Terri and @brooklyngirl for clearing that up for me. It just seems weird to me from the outside looking in.... It's like having a store and putting a $1,000,000 price tag on something and having a shill say "oh that's a bargain!" hoping someone will be gullible enough to agree. But oh well.
I don't understand why a lot of these surgeons don't just give me a fair price, as they're earning less with insurance. But oh well. I think Greenbaum is the only doc in the country that is charging comparable prices. I understand getting a bit more, but it feels like price gouging (or @Spiky Bugger's greasy used car lot salesman).

It does feel like that, and it's unfortunate. I can reiterate what someone said recently, though- we take out loans for cars for just as much, if not more money, but so few people think to do that for our health. I, for one, never thought of it that way before. I was desperate to get the surgery done before my insurance coverage ended, thinking that once it ended, the expense was no longer a possibility. Knowing what I know now, I would 100% get a personal loan or apply for another credit card and pay it off monthly. If I pay that much to my car company or the cable company, why not to improve my life in an immeasurable number of ways? Now, that being said, it sounds like you're being smart in terms of trying to find a top-notch surgeon for the best price, and you're probably providing lots of info for people that are researching but not posting, so bravo

 

[jillc]

It is an investment in your future totally @brooklyngirl. I used to be a RMT. And not the nice kind, a therapeutic massage therapist who did deep tissue and sports massage. I used to say that we would take our vehicle in for an oil change every 5,000 Kms (insert mileage equivalent here) but not our bodies. We don't tend to invest in ourselves as much as we invest in 'things'.