PDA

View Full Version : do you pay cash for dr. boachie?



theizzard
08-16-2008, 08:10 AM
I have heard that dr. Boachie does not take insurance. does that mean that people on this board who have had surgery with him, have paid cash out of pocket for the surgery? i imagine you would try to recoup from out of network benefits if you have them but please tell me if this is true. cash out of pocket for surgery with him? i know that the first consultation is between 500-650 because they told me that on the phone but if i have to pay cash then i don't need to spend the consultation money. surgery has to be many, many thousands of dollars maybe even 100K.
thanks to all who will answer me.
avis

debbei
08-16-2008, 12:46 PM
Hi Avis,

I decided not to go with him, but I did have a consultation where I paid via credit card. I brought films from another doctor, so my consultation was $450. I sent it into my insurance as out of network, and believe it or not, they paid me back $350. His insurance lady told me that my insurance pays very well, around 70% of his bill. For me it would also depend on if I had a textbook case that goes as planned, or I would haveto stay in the hospital longer. HSS is not in my insurance either. I'm glad I won't have to worry about that as the surgeon I picked is in my network.

It's hard worrying about these $$ issues as well as the operation itself.

Good luck,

2lucky2
08-16-2008, 01:42 PM
I have been to see Dr. Boachie 4 times before deciding on having my surgery. For all these visits I paid with a Credit Card (he does not take Discover), and then submitted to my insurance for out-of-network coverage.
At this time I am trying to find out how much my insurance company will pay for Dr. Boachie's surgery bill. Theresa, the Chief Billing person in the office, has submitted an estimate with the CPT codes. My primary insurance, out of network benefit is only 50% but does have a max. out of pocket. I spoke to my insurance company yesterday and they explained that once I meet the max out of pocket for the year they will pay 100% of the R/C fee. I am lucky as I also have a second insurance under my husbands plan.
The estimate for Dr. Boachie'e bill is $216,700, this is for A/P revision surgery. I am hoping that with the two insurance's I will not have to pay to much out-of-pocket.

Arlene

theizzard
08-16-2008, 04:20 PM
Debbei,
who did you decide to go with if you don't mind me asking?
avis

debbei
08-16-2008, 04:23 PM
Debbei,
who did you decide to go with if you don't mind me asking?
avis


Hi Avis,

I'm going with Dr. Neuwirth, who is also in NY city. Luckilly for me, he takes Aetna insurance, which we have. For some strange reason, it's the only insurance he takes. His opinion & approach to surgery matched what Dr. Boachie said, and Dr. N could take me months earlier. Those were all factors in the really HARD decision on who to go with. I feel comfortable with my choice, and I'm 2 months and counting till D day.

debbei
08-16-2008, 04:24 PM
I have been to see Dr. Boachie 4 times before deciding on having my surgery. For all these visits I paid with a Credit Card (he does not take Discover), and then submitted to my insurance for out-of-network coverage.
At this time I am trying to find out how much my insurance company will pay for Dr. Boachie's surgery bill. Theresa, the Chief Billing person in the office, has submitted an estimate with the CPT codes. My primary insurance, out of network benefit is only 50% but does have a max. out of pocket. I spoke to my insurance company yesterday and they explained that once I meet the max out of pocket for the year they will pay 100% of the R/C fee. I am lucky as I also have a second insurance under my husbands plan.
The estimate for Dr. Boachie'e bill is $216,700, this is for A/P revision surgery. I am hoping that with the two insurance's I will not have to pay to much out-of-pocket.

Arlene


You are so lucky to have 2 insurance plans covering you. You really don't see that too much lately. I think fondly of the days my hubby and I had that....now we're paying for family cobra coverage. OUCH...but still, thank goodness for it because that's why I'm able to have Dr. Neuwirth perform my surgery.

txmarinemom
08-16-2008, 04:56 PM
... has to be many, many thousands of dollars maybe even 100K.

Avis,

I just had surgery 6 months ago (an uncomplicated first surgery, fusion and instrumentation from T4-L1), and all the assorted bills (of course my insurance covered most of it) came to roughly $260,000.

Yowza.

Pam

Janet
08-16-2008, 06:04 PM
Doctor Boachie did my surgery in December 2007; I am fused T2 to L2, 11 hours surgery, 15 days at HSS (including an extra 5 days in ICU for pneumonia I got 1 day post-op). For my type of surgery, his fees (and I suppose all other spine surgeons') are based on the number of vertebrae involved: the 1st is one price, the others are all another (slightly lower) price but same amount for each vertebrae. There is a separate procedure code for the "slice & dice" and another code for the instrumention. My bill from Dr. B was $219,500. The other doctors involved (e.g., anesthesiologist) bill seperately, probably $20 - $25,000 total. So far my only payments directly to Dr. B. were for 2 consultations, paid with credit card.

I had Blue Cross of CA, and all these doctors involved are non-network, so my insurance paid a lower amount (I'm fighting with Blue Cross now because of the pittance they have paid to Dr. B thus far). HSS is in network with Blue Cross of CA, so I paid nothing to HSS - HSS bill was about $200,000 but they were paid about $65,000.

I consider myself as now having a "million-dollar body" :D because my subsequent stomach surgery bills were about $230,000 for the hospital (20 days) - BC paid about $75,000 - and about $130,000 - paid about $55,000 - for the surgical team, plus lots of other incidentals such as pre-surgery diagnostics, ambulance, etc, that came close to about $30,000. Thankfully all of these services we in-network, so I had to pay only my annual deductible of $2,400. Also covered fully were the NYC rehab hospital fees (14 days) that were billed at about $200,000 and various doctors and physical therapists at rehab.

Hope this helps somewhat.

Singer
08-16-2008, 06:16 PM
Paying cash out of pocket?!? :eek: Good Lord, no. My insurance plan (NY-based Blue Cross, since my husband's employer is headquartered in NY) paid for almost 80 percent of Boachie's total bill, and he wrote off the difference after I called Theresa and basically asked her if I HAD to pay it. My hospital stay was totally covered. We did end up paying a few thousand in out-of-pocket fees, but in the grand scheme of things it was well worth the expense.

briarrose
08-16-2008, 09:14 PM
I had surgery at the end of May this year and my bill for the hospital and surgery was $280,000. Adding all the other stuff in, it was well over $300,000. This was done in the Philadelphia area.

theizzard
08-16-2008, 09:15 PM
well it sounds better than i had thought. i really was beginning to think that i needed a couple hundred thousand laying around with nothing to do. i am reassured. i have personal choice with out of network benefits so they do pay something, thanks everyone/
avis

tillgurl
08-16-2008, 11:24 PM
This is kind of unrelated...but I'm just wondering because I live in Canada....do Americans have to pay for surgery for Scoliosis?
If so, approximately how much? :confused:

txmarinemom
08-17-2008, 01:28 AM
This is kind of unrelated...but I'm just wondering because I live in Canada....do Americans have to pay for surgery for Scoliosis?
If so, approximately how much? :confused:

Tillgirl, I had to stop laughing before I could answer :).

Yes, hon ... in America, pretty much if you don't have insurance (or aren't under 18 - Shriner's Hospitals will operate for free on anyone from birth to 18 - and in special cases, I believe even on over 18's who were treated prior to their 19th birthday), you don't have this surgery. Few people have the monetary resources to self-pay.

America in no way operates under a socialized medicine system. We pay monthly premiums for insurance coverage, and there are different types of plans:

An HMO (Health Maintenance Organization) plan requires the insured to see their PCP (Primary Care Physican ... just their general practioner) for a referral to any specialist. The downside to this is a LOT of GP's don't know sh** about special conditions, and the HMO itself does all it can to save the money a specialist demands.

A PPO (Preferred Provider Organization) has a list of GP's and specialists they consider "in-network" (the term you see so much). They have contracted prices for services with these doctors, and the doctors are not allowed to charge over that price. Out-of-network benefits (to doctors who aren't contracted in the plan) are usually much less, and have a completely separate deductible (the amount the patient has to pay before ANY insurance benefits are paid).

Recently, a new type of insurance has surfaced ... the HDMP (High Deductible Medical Plan). This is what I have. My out of pocket expenses before insurance pays is $2500 - and then everything is paid the rest of the year at 100%. I scheduled this surgery in late 2007 for early 2008 - and enrolled in this plan knowing I'd have excessive medical expenses in 2008. I met everything (deductible, out of pocket, etc.) in February 2008 - and all my expenses are covered completely for the rest of the year.

You can also set aside tax-free monies (in either flex spending accounts or health savings accounts) to help you pay out of pocket costs.

There are obvious downsides to a non-socialized system (for instance, not having insurance and needing scoliosis surgery ... which to answer your question averages $250,000 - $300,000 ... and easily more for complex revision surgeries).

There are also upsides: We don't have to wait months (usually) for appointments and medically necessary surgeries, and we can schedule even elective surgeries without delay. That convenience comes with a hefty pricetag.

Feel free to ask away if you have other questions! I'm sure I've made it clear as mud ;-).

Regards,
Pam

theizzard
08-17-2008, 05:18 AM
so, in other words, dr. boachie takes what he gets from our insurance even if he is not a participating member and we don't have to pay the difference?
avis

debbei
08-17-2008, 07:37 AM
so, in other words, dr. boachie takes what he gets from our insurance even if he is not a participating member and we don't have to pay the difference?
avis

I think it depends what % your insurance pays. I've heard that some insurance plans only pay 10-20% of his bill; in that case he would need to collect more.

Janet
08-17-2008, 12:07 PM
I was told by Dr. B's insurance person, Theresa, that he expects to receive 80% of his bill; i.e., the patient is expected to make up any shortfall of the 80% after insurance. Remember that insurance companies exist to make a profit, not to pay our medical bills. Typically their initial payment is really low, so you then have to appeal their decision, and if you make enough noise (including saying you will notify the state insurance commissioner), they may, eventually, come around and pay a much greater amount.

It is really difficult to make a decision as to choice of surgeons when you are not given sufficient information beforehand re finances; we spend many many hours doing due diligence as to selecting a surgeon whose skills you trust, but we don't have that choice re finances.

theizzard
08-17-2008, 02:20 PM
so janet, did you have to pay him the difference or did you wear the insurance company down and get them to pay him more money. my insurance is only 70% for out of network benefits. i for one can't afford to sink into that kind of debt even if he is the best surgeon out there.

debbei
08-17-2008, 07:26 PM
so janet, did you have to pay him the difference or did you wear the insurance company down and get them to pay him more money. my insurance is only 70% for out of network benefits. i for one can't afford to sink into that kind of debt even if he is the best surgeon out there.

You also have to consider that out of network is 70% of 'Reasonable and Customary' for the surgury. Unfortunately for us, 'Reasonable and Customary' charges can be MUCH less than the doctor's billed rate.

txmarinemom
08-18-2008, 12:46 AM
You also have to consider that out of network is 70% of 'Reasonable and Customary' for the surgury. Unfortunately for us, 'Reasonable and Customary' charges can be MUCH less than the doctor's billed rate.

Which brings up another b**ch of mine for all the surgeries I've had (knees, ankle, scoli, too many others to list) ... Anesthesia is ALWAYS above "Reasonable and Customary".

Why don't insurance companies UP the R&C on this, or someone make anesthesiologists LOWER their charges? This is definitely an area where the the state(s) Insurance Commission should be involved.

They're the only ones guaranteed you'll owe (even if your insurance is paying at 100%!).

Regards,
Pam

amber24
09-06-2008, 02:04 AM
I had my surgery done when I didn't have any health insurance! I was blessed with the help I received! I think my total was over $300,000 due to the fact I had to be readmitted two weeks after my surgery was completed.