Cost of Health Care
Has anyone else been tracking their medical expenses from this injury? Sure makes me happy that I was insured when the injury happened. Granted, I probably would have opted for the non-surgical treatment if I didn’t have insurance, but the cost is still staggering. I’m also glad that I was able to make a choice with regards to treatment based on what was best for my long term well being.
I don’t want this to turn into a health care debate, so I’ll hold back any commentary regarding health insurance. I’m just curious about the expense involved with this relatively routine surgery. I can’t even begin to imagine the cost involved with open heart surgery, cancer treatments, etc.
I believe I’m closing in on $11,000. This includes ER visit, pain meds, crutches, surgery, casts, boot, post op visits, etc. The only thing not included is physical therapy. I’m guess that with PT added in I’ll be over $12,000. I can think of a lot better ways to spend $12,000. The good news is that I have a high deductible HSA through work, so I was 100% covered as soon as I hit the deductible limit. That probably occurred sometime around when they stuck the IV in my arm before surgery! The bad news is that my HSA is now drained.
Anyone else care to share what their medical expenses have been so far?
Filed under: Uncategorized
Tom - sounds like we are in similar markets…here are my expenses to date (~5.5 weeks post op)
- $11,419.30 ($9500 was the surgery, hospital and surgeon and anestheologist)
- $590 paid OOP to date, for deductable and co-pays - I am extremely lucky to have a fantastic health care coverage at work.
I was a bit surprised when I got the hospital EOB ($8K), because we (insert *chuckle* from my wife, “what do you mean we”) birthed children at the same hospital, and the bill for each was $4100 for natural birth, no epidural, but still two nights stay for mom and baby. Just seemed like we got more “care” in those few days, but who knows?
I don’t have the exact figures in front of me, but it’s probably about the same for me as well.
Did you know that if you don’t have health insurance, the hospital charges individuals several times more than what they charge the health insurance companies? (sometimes like 300% - 500% more)
The insurance companies get group rates and individuals get “regular” rates.
So if you don’t have insurance, not only are you paying for your own hospital bills, but you are also paying several times more than what the insurance companies typically pay. double screwed!
To think that I considered going without insurance this year, as I’ve always been healthy except for the occasional colds!
I’ll post the actual figures in a few weeks when I can get all my paperwork straightened out.
The story that follows is by far the most embarrassing part of my injury. As some may know from reading my posts, I’m an ER nurse (sorry for the waiting room times;). I had just moved and was going to start work in about 10 days, and with plentiful jobs, I was still mulling my options. My previous heath coverage had expired about 1.5 weeks prior to my injury, and although I did think about it, I knew I would have insurance soon. And along the lines of what Dennis said, I think I have seen the doctor 2x in the last 6 years. So what’s a nurse doing without insurance? Good question. As soon as the tendon popped, that’s all I could think about, no insurance. I heard somebody say “call an ambulance” and I yelled “NO AMBULANCE”. Then somebody wanted to take me to the ER, which I refused also, knowing they would basically do noting but send me a bill. Heck, I had my ABC’s (airway, breathing, and circulation) so it couldn’t be that bad right? The one advantage I have is knowing how the system works, and how to work the system, a bit. I knew within seconds I needed surgery, and I knew I needed ortho, so I self refered after calling many doctors in the area. The advantage here is I could shop a bit and find a doctor I was confortable with, and not just get the on call. It was a very surreal experience shopping for someone to fix me as if I just need a new clutch and brakes at a good price. Insurance takes a long time to pay, and they don’t always pay what the doctors/hospitals charge. I negotiated a discount by offering to pay in advance and the orthopedist gave me a 50% discount for paying in advance, so the bill from the ortho was just under $1,500. I didn’t want to have the surgery in an outpatient surgery center, nor did my MD, so I then had to deal with the hospital OR charge. With some help from the MD’s billing staff, I got a fairly good deal. The OR estimate was about $14,000 (which is actually very close to the final bill). If I paid in advance, I was told the maximum out of pocket would be $4,000, that a smokin’ blue light special of about 70% off! The next an final attempt to break me would come from the anesthesiologist. Since there was no way to know who or what group it would be, I couldn’t negotiate prior to surgery. Once I got the bill though, I was able to get a 25% reduction by paying in full, bringing that to $1,100. A very painful, embarassing lesson to say the least, but I was glad I knew my way around a very confusing system. I would have paid 10x that to have my leg work normally again though. The short term insurance I had considered had a very high deductible of $5,000, so it wouldn’t have covered that much. It was a very scary experience. Everybody I have dealt with though has really been great, and wanted to help me as much as possible, and I’m thankful for that.
What’s that na-na-na-na-na noise I hear? Look out! It’s the “Just Over Six-Thousand Dollar Man” limping in my direction.
Jim
And yes, I have insurance now.
Jim..
way to work the system. I encounter patients without insurance all the time. Based on the fact that we don’t have to file claims, bill, rebill, resubmit, use a collection agency we have a time of service discount…saves everyone the headache of dealing with ‘the system”
Doc Ross
Dennis..
I hear what you’re saying but my experience and reading what Jim wrote you can definitely negotiate with health care services. They don’t want to wait for payment or deal with cost associated with collecitons. So don’t be afraid to ask for them to decrease their bill.
Doc Ross
Jim and Doc - Thanks for sharing that. I didn’t realize that you can negotiate to lower the price of health care. That’s really good to know, and I hope more Americans without insurance know about that as well.
Maybe a page on “No insurance? How to navigate the health care system and save $$” would be helpful for the uninsured and uninformed.. which is probably about half the country.
This post was quite helpful when I began my journey back to two feet. I am also a “cash patient.” I specifically asked the doctor’s office and surgery center if they had tiered rates (insurers vs. us) and they vehemently claimed that had one price. For my own sanity, I believe them. The good news is that they give a 20% discount off those prices for cash (actually checks/credit cards).
I had my procedure done at a surgery clinic (in by 11 and out by 3) and am in Week 4 of recovery. I’ve been keeping a log and here are the costs so far:
Crutches $43.20
Ortho office visit (with x-rays) 400
The Boot 90
Pre-op physical (state required) 300
Operation (incl surgeon and anesthesiologist) 6800
Parking (why they can’t include that, I don’t know) 8
Meds 35
Follow up office visit #1 300
Physical therapy (12 sessions planned) 1200
And the total is…geez…I don’t wanna know. I’ll wait for tax season next year.
BUT…the good news aka the silver lining:
-I was able to dictate my treatment without the confines of a crappy individual health plan (no worries of in-network/out-of-network)
-I was able to skip seeing a GP to get the needed/dreaded referral to a specialist. This may have saved day(s).
-All the business admins I spoke to were understanding and tried to shave off as much as possible
-If I had a catastrophic health policy it most likely would have had a $5K deductible. Add that to the annual premiums and I’m not too far above that.
-My surgeon uses a surgery clinic (out-patient) as opposed to a hospital. This was a much better way to go.
-This procedure is one of the cheaper surgeries out there. Apparently, bunion surgery is more complicated and more expensive.
The DOWNSIDE (besides spending the cash) is that, in California, I am ineligible for acceptance into an individual policy now because of this “pre-existing” condition. I have to be out of a doctor’s care/supervision before I can apply for one. California is one of the states that does not allow for exclusions in health policies (except for maternity as far as I know).
Oh well…hopefully this helps someone.
Thanks to everyone for your input! I had a complete rupture of my right achilles tendon on Sunday, June 29th, 2008, while playing frisbee with my two sons in law. I jumped to grab the frisbee with my left hand, heard a “pop” and felt like a hardball had hit my ankle. My son in law who is a cardiologist heard the pop and surmised that I had torn my tendon. I will have surgery on July 3rd. Fortunately I have health insurance. I will keep track of my expenses and comment later.
hey i am hoping its only about $15,000.
i was hit by a car and the hospital is doing it on a lien basis.
meaning they are taking $ out of the settlement i get.
i had the surgery and everything and when i asked the surgeon how much he said he hadnt looked at the bill but he was guessing anywhere from 20-30k.
could this be possible? how can i find out if he is charging me unfairly?
help!
email me ptrontheirc@yahoo.com
thx
Approximate figures follow…I was uninsured right between jobs…ouch
Ortho - $1,500 after 50% off for paying in advance.
Anesthesia - $1,100 25% discount for paying bill in full.
Hospital (OR outpatient) - $4,000 negotiated down from $13-$15K for paying cash in full.
Physical therapy - $$1,500 33% discount for paying cash each session.
Odd and ends: Crutches, Braces, Bandages, Multiple pairs of shoes worn out in less than a month, etc. - $1,000
Approximate total - $9-$10K
Looking forward to having a fully functional left leg - PRICELESS
I’d have paid 10x that (glad I didn’t have to) to be healthy. You can be sure that Murphy won’t be riding shotgun any more as far as medical insurance is concerned.
Jim
Here are my costs to date - but I have California company plan and live in Oregon and that has made some complications in the system as well as some advantages - I have a great plan, but in Oregon they don’t have all the rules (see post of daveleft) …(keep in mind I’ve already paid my plans deductible this year)
1. Stanford, Cali Hostpital Visit - 50$
2. AShland OR ER Visit - 50$
3. MRI - 120$ - 10% of the cost of the MRI
4. 40$ in Copays - misc doc
5. PT - 300$ cost to pay and drain first out of my pocket before they will start billing insurance. THen 20$ an appt after that.
6. approx 200$ in misc I don’t know what bills that come in teh form of 13$ here, and 7$ there.
7. Wheel chair - 60$
8. pain meds and advil etc - 25$
My surgery was about 14K according to the insurance. I haven’t paid yet for that (crossing fingers)
So medical is about 785$ as of today. The tax discussion in April will be interesting what tricks you folks out there do…..Anybody a “taxman” out there?
Other volunteer items
1. viti’s and other misc vitamins and scar rubs - 50$
2. Achillestrain brace - 110$
3. Boy soccer socks, compression socks, mini brace - 100$
4. Hired a housecleaner and daily helper for first six weeks - approx 1200$ (can I write her off???)
5. Having food delivered (live alone - hard to cook) - have no idea - but WAY too much.
I have saved in gas, and travel and Entertainment, in fact, I saved about 6K from not going on a Europe trip for three weeks…..not sure thats a good thing…but there it is.
I really feel for the folks with no insurance and wish I could help in anyway. I hope to donate a lot of my items to Dennis’ site for future folks, and just wish I could offer some sort of relief.
chat soon. Go bears.
I’m Canadian and I’m floored by these numbers.
I blew my achilles out two Fridays ago, stayed in Emerg overnight because they made a bed up for me, saw the ortho specialist the next day and he said he was free to do surgery that day. I had a spinal, surgery took about an hour and I was home by 3pm.
They gave me crutches on the way out the door and a bill for them for $30. Apparently 80% will be covered by my work’s health insurance.
Stopped to pick up a prescription of Dilaudid on the way home - $3.56 after my company insurance.
2 weeks post-op I got my wraps off and an air-cast instead. $140 charge, pending insurance coverage which I guess will be 80% again.
I’m cheating though because my mom is a physiotherapist, but that cost would most likely be covered by our universal health care or my insurance.
Anyway, just thought I would share a different experience.
I too, did not have health insurance when my achilles snapped playing softball. My softball league is insured but my doctor does not accept third party insurance. When I was told I needed surgery I immediately explained to the staff about my unfortunate, and stupid situation concerning the lack of insurance. The office manager said that the surgery would cost anywhere from $7000 to $10,000. My husband called the following day to discuss payment plans and the cost was reduced to payment of $5000 up front, anestesia included. I’ll submit the bills to the insurance company and see what happens.
I’ve learned 2 lessons–I will never go without insurance again and, sometimes it pays to ask questions. Surgery on Tuesday, July 21st. Wish me luck and good luck to all!
Wow, Thought I would give an Australian Perspective.
Many of those numbers above, like Vcela said…floored me.
I went via our private systems as I have top the hospital cover plan. (appx $ 2500 AUD per year for a Family)
Private Hopital for initial diagnosis…(I already knew the problem because my brother in law did it 4 months ago) $ 300
Ultrasound before I was allowed to get a referral $ 70 Full rebate from Govt Health.
Follow Hospital Visit for referral…wow there is some red tape in getting to see a surgeon…$ 55
Surgeon 5 min visit to confirm and book surgery $ 170 (50 rebate from health fund)
Hospital for Day Surgery inc Assistant Surgeon, Anesthetist, etc…about $1500 our of pocket after Health Fund rebate about $200
I’ve just got back from my 2 week follow up to get out of the cast and into a boot and the Surgeon saw me for 1 min to check healing…no cost…Physio to fit boot $ 70 ($35 back from health fund) and the boot ($ 200)
I don’t see another medial person now for 6 weeks (I can adjust my own boot angle every 2 weeks or the physio will do it free if I drop by). and I’m out of pocket under $ 500 AUD (appx 180 Pounds or $ 400 US)
and that is the via the private system..If I went public it would be mostly free, but god knows how long to wait before an operation…weeks, months…didn’t even want to find that out…
But even without insurance…$ 2500 AUD would probably cover most of it so far.
Hey, i’m an Aussie too and i went through the public system. I ruptured on 13/6/09 and was operated on the next day. I was put in a cast and 2 weeks later was put into a walking boot. The only down side is that I have to go to the clinic to see the surgeon and that can be a wait of about 1 - 2 hours. I also complained about a sore calf when i was there for the first visit but they weren’t worried and were very busy (saw local GP and was diagnosed with a large DVT) but other than that have been very happy with the public system. Seeing surgeon tomorrow and am hoping to be walking out of there in 2 shoes!! Still haven’t had physio yet so hoping he gives the green light for that as i am dying to drive!! Good luck with your recovery. Tina
Another Aussie here commenting on costs.
I originally planned to go public but ended up going private to get choice of surgeon.
Costs:
ER visit - public, seen in 1 hour, discharged with back slab cast: Free
Hire of crutches: A$30
Orthopaedic clinic visit - public, seen after about 20 minutes, review by student, registrar and consultant, ultrasound confirmation of complete rupture and marking for incision, new front splint plaster: Free
Private orthopaedic surgeon pre-op consult: $66 fully refunded by Federal govt “Medicare” (normally would pay about $80 out of pocket but wife is also a doc and docs look after each other!)
Surgery, anaesthesia, boot (fitted in hospital), day bed in nice private hospital: $0, it was fully covered by my insurance (for which I pay A$600 p/a for a fit 36yo male, hospital and ambulance cover only). Public hospital cost would have been same, i.e. nil.
Discharge meds: antibiotics, endone, panadeine forte: A$45
2 x follow-up surgical consults: included in surgery fee, no out of pocket.
Physiotherapy: not covered under my insurance and I don’t think I’ll have more than 2 sessions - A$240 (A$120 per session)
That would have been all the costs, except today I have a bit of a skin infection around the wound, and the surgeon couldn’t fit me in for an appointment (which would have been free to as he doesn’t charge post op care above government rebate) so:
GP consult: A$66 (half refunded by federal govt)
Antibiotics: A$15
Grand total: A$363, or less than US$300, two thirds of which is for PT.
If I had gone through the public system, the total cost would have been $30 (hire of crutches), and physiotherapy and rehab aids would have been provided through the hospital outpatient department at no cost.
As far as cost without insurance to go private, I believe it would have been about A$1500 out of pocket after what the government pays through Medicare. Total cost without insurance or government rebate would have been under A$5000/US$4000 by my guess.
Maybe some of you Americans should consider a holiday over here to get your surgery done, even after airfares and hotels you would still be saving money if you don’t have insurance
As a comparison, here in the UK with private treatment paid for by my husband’s corporate insurance, so far it’s cost:
Initial consultation = £150.00
MRI scan = £618.00
2 night hospital stay + op theatre = £2446.80
Consultant’s pre-op + surgery fee = £908.00
Anaesthetist’s fee = £165.00
Post-op check-up + cast = £301.00
Check-up + cast-change = £206.00
That’s £4794.80 so far (GULP!) and have another cast change today plus (if all goes to plan) cast-removal/check-up on Sept 8th followed by as yet undecided number of PT sessions.
Husband says I’m worth it! But then he’s glad to be getting some money back for the tax his corporate insurance costs him each year.
I’ve also bought a couple of pieces of equipment, which I may be able to resell or donate to charity:
Used wheelchair = £96.98
Crutch carrier bag for wheelchair = £17.99
Fingerless gloves for wheelchait = £6.98
Shower chair = £27.49
Half-leg cast cover = £17.00
Folding walking stick (in readiness!) = £7.90
Replacement crutch ferrules = £6.18
That all totals £180.53.
Crutches are borrowed from NHS A&E (who misdiagnosed me, hence going private).
Sam