PDA

View Full Version : How Much Does the Surgery and Hospital Stay Cost?



Irina
07-31-2012, 05:31 PM
We have an open enrollment at work right now and I have an option to change my insurance plan. It will be Blue Shield, but they offer several different “flavors” of it. Some pay 75% for surgeries and hospital stay, some pay 80%, some pay 90%. The 75% doesn’t have any premiums (they won’t deduct anything from my paycheck), but I would have to pay a premium for 80 or 90% plans.

I am hoping that someone can give me a rough estimate of how much anterior-posterior surgery and hospital stay BEFORE INSURANCE would cost. Are we talking $50k or $300K? Then I can do math and figure out if paying premium for 90% plan worth it.

Thank you!

Doreen1
07-31-2012, 06:57 PM
Hi Irina,

My total hospital and surgeon fees ran $700k + and total out of pocket was $485.00. If you decide to change your insurance and you have already selected a surgeon, but sure he falls within the in-network category to get maximum coverage of fees.

Warmly,
Doreen

susancook
08-01-2012, 12:46 AM
I have not had surgery, but have worked in the medical system. From what I remember that you said that you would have done, you may want to go for the 90 percent coverage.
Susan

titaniumed
08-01-2012, 03:14 AM
Irina

I will keep this short, get the best insurance you can.

780K for the hospital. I don’t know about the surgeons, I had 3 of them. That’s 3 big bills. (smiley face)

The insurance company loves me, and I love them also.

Ed

Irina
08-01-2012, 11:41 AM
Thank you all for your responses. Another question - out-of-pocket maximum. Blue Shield website says that this is the maximum amount a patient will pay out-of-pocket, but there are some exceptions that are not specified. I think that out of pocket amount is the key in financial decision making in my case (assuming this surgery is not an exception to out-of-pocket rule).

Let's say I'll go with 90% coverage and the surgery costs $700,000, then I'd have to pay the lesser of out-of-pocket maximum of $6,000 or $700,000 x 10% = $70,000. So, I am responsible for $6,000 only, right?

susancook
08-01-2012, 02:45 PM
Thank you all for your responses. Another question - out-of-pocket maximum. Blue Shield website says that this is the maximum amount a patient will pay out-of-pocket, but there are some exceptions that are not specified. I think that out of pocket amount is the key in financial decision making in my case (assuming this surgery is not an exception to out-of-pocket rule).

Let's say I'll go with 90% coverage and the surgery costs $700,000, then I'd have to pay the lesser of out-of-pocket maximum of $6,000 or $700,000 x 10% = $70,000. So, I am responsible for $6,000 only, right?

Sounds right to me, but if I were you, I would call the insurance company and ask them. Always keep a log of the date, time, and person that you talked with. Get everything in writing.
Susan

lisazena
08-01-2012, 05:18 PM
Thank you all for your responses. Another question - out-of-pocket maximum. Blue Shield website says that this is the maximum amount a patient will pay out-of-pocket, but there are some exceptions that are not specified. I think that out of pocket amount is the key in financial decision making in my case (assuming this surgery is not an exception to out-of-pocket rule).

Let's say I'll go with 90% coverage and the surgery costs $700,000, then I'd have to pay the lesser of out-of-pocket maximum of $6,000 or $700,000 x 10% = $70,000. So, I am responsible for $6,000 only, right?

Hi,
I haven't had surgery yet, but I talked to two surgeons about it and it not only depends on the insurance company; it depends on the surgeon and if he is willing to take the insurance company's customary rate. I know it's not easy to figure out.
Lisa

golfnut
08-01-2012, 08:12 PM
I have Health Link Insurance and my out of pocket expense was $250. I couldn't believe it!

hasteffen
08-01-2012, 09:06 PM
I haven't had my surgery yet, but I have a high deductible plan. Our deductible is $7,000 for the family. After $7000 is met everything is covered 100%.
I think it would be wise to go with the best plan you can get since you know you are going to have surgery.
Best,
Heidi

HannahCP
08-01-2012, 09:33 PM
Hi there,

I haven't had the surgery yet either, but I have to basic core plan that my company offers(Through Blue Cross Blue Shield), which for an individual is a $500 deductible, $3000 Out of pocket maximum. So you may want to check with either insurance provider or benefits person at your work to find out what your best option would be. They usually have the best advice. But you shouldn't have to go higher than your OOP.

mabeckoff
08-01-2012, 09:40 PM
My second fusion surgery was over one million dollars . We did not have to pay anything . We have BCBS and it is an excellent plan.

Marina63
08-02-2012, 07:12 PM
Just to throw my numbers in the mix...my surgery was $130,000. I think I paid about $500-$600 out of pocket.

My surgery was simple, no complications, in and out of the hospital in five days.

Good luck!
Marina

debbei
08-03-2012, 12:29 PM
Get the best insurance you can. This is a very expensive surgery. It will be worth it over the long run.

djkinkead
08-03-2012, 08:49 PM
In the end my surgery was about $140-$150K. I also have BCBS--out of pocket was around $5K. I went to a hospital that BCBS classified as a Blue Center of Excellence (or whatever they call the term)--that was suppose to give you better benefits. I had a private room because of it being that standard with the hospital.

You need to find a doctor and a hospital that is in your insurance plan, otherwise there's a bit of play between the surgeon and the insurance...not sure how it works.

rohrer01
08-04-2012, 04:13 PM
I haven't had scoli surgery, either. I have had some experience working with different insurance plans with different medical issues. The OOP is "supposed" to be the maximum you will have to pay for the year. I would recommend going with the 90% plan as well. You don't want any hidden loop holes that the insurance company can wiggle through, because they will if they can. You also have to consider that "the surgery" may not be the end of your medical needs through the year. You may well have to go for rechecks and other things that may crop up unexpectedly. You don't want to end up having medical bills you didn't count on. Also, you can work out payment arrangements with the hospital if you aren't able to come up with the cash for the difference at the time of surgery.

My mom had an emergency reattachment surgery (don't know what insurance she had at the time) and the hospital wrote off the balance. It might help to speak with someone from the hospital as well as the insurance company beforehand.

Irina
08-05-2012, 03:51 PM
I haven't had scoli surgery, either. I have had some experience working with different insurance plans with different medical issues. The OOP is "supposed" to be the maximum you will have to pay for the year. I would recommend going with the 90% plan as well. You don't want any hidden loop holes that the insurance company can wiggle through, because they will if they can. You also have to consider that "the surgery" may not be the end of your medical needs through the year. You may well have to go for rechecks and other things that may crop up unexpectedly. You don't want to end up having medical bills you didn't count on. Also, you can work out payment arrangements with the hospital if you aren't able to come up with the cash for the difference at the time of surgery.

My mom had an emergency reattachment surgery (don't know what insurance she had at the time) and the hospital wrote off the balance. It might help to speak with someone from the hospital as well as the insurance company beforehand.

Thank you all for your comments. I spoke with UCSF Finance Department and they told me that I should not be paying more than OOP maximum. Just to be safe, I enrolled in a plan with reasonable OOP maximum and 90% coverage. I was thinking along the line that you mentioned - better be safe than sorry.