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Thread: How Much Does the Surgery and Hospital Stay Cost?

  1. #1
    Join Date
    Apr 2012
    Location
    San Jose, CA
    Posts
    571

    How Much Does the Surgery and Hospital Stay Cost?

    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!

  2. #2
    Join Date
    Jul 2011
    Posts
    535
    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
    44 years old at time of surgery, Atlanta GA

    Pre-Surgery Thorasic: 70 degrees, Pre-Surgery Lumbar: 68 degrees, lost 4 inches of height in 2011
    Post-Surgery curves ~10 degrees, regained 4 inches of height

    Posterior T3-sacrum & TLIF surgeries on Nov 28, 2011 with Dr. Lenke, St. Louis
    2 rods, 33 screws, 2 cages, 2 connectors, living a new life I never dreamed of!

    http://thebionicachronicles.blogspot.com/

  3. #3
    Join Date
    Jan 2012
    Location
    Yacolt, WA
    Posts
    1,595
    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
    Adult Onset Degenerative Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Severe disc degen T & L stenosis

    2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 2 surgeries
    2014: Hernia @ ALIF repaired; Emergency screw removal Spinal Cord Injury T4,5 sec to PJK
    2015: Revision Broken Bil T & L rods and no fusion: 2 revision surgeries; hardware P. Acnes infection
    2016: Ant/Lat Lumbar diskectomy w/ 4 cages + BMP + harvested bone
    2018: Removal L4,5 screw

  4. #4
    Join Date
    May 2008
    Location
    reno,nevada
    Posts
    4,131
    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
    49 yr old male, now 61, the new 61...
    Pre surgery curves T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  5. #5
    Join Date
    Apr 2012
    Location
    San Jose, CA
    Posts
    571
    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?

  6. #6
    Join Date
    Jan 2012
    Location
    Yacolt, WA
    Posts
    1,595
    Quote Originally Posted by Irina View Post
    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
    Adult Onset Degenerative Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Severe disc degen T & L stenosis

    2013: T3- S1 Fusion w/ ALIF L4-S1/XLIF L2-4, PSF T4-S1 2 surgeries
    2014: Hernia @ ALIF repaired; Emergency screw removal Spinal Cord Injury T4,5 sec to PJK
    2015: Revision Broken Bil T & L rods and no fusion: 2 revision surgeries; hardware P. Acnes infection
    2016: Ant/Lat Lumbar diskectomy w/ 4 cages + BMP + harvested bone
    2018: Removal L4,5 screw

  7. #7
    Join Date
    Mar 2011
    Location
    Philadelphia
    Posts
    79

    Depends on the surgeon

    Quote Originally Posted by Irina View Post
    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
    60 degree thorocolumbar curve beginning at T12
    58 years old

  8. #8
    Join Date
    Apr 2010
    Location
    Waterloo, IL
    Posts
    1,707
    I have Health Link Insurance and my out of pocket expense was $250. I couldn't believe it!
    Karen

    Surgery-Jan. 5, 2011-Dr. Lenke
    Fusion T-4-sacrum-2 cages/5 osteotomies
    70 degree thoracolumbar corrected to 25
    Rib Hump-GONE!
    Age-60 at the time of surgery
    Now 66
    Avid Golfer & Tap Dancer
    Retired Kdgn. Teacher

    See photobucket link for:
    Video of my 1st Day of Golf Post-Op-3/02/12-Bradenton, FL
    Before and After Picture of back 1/7/11
    tap dancing picture at 10 mos. post op 11/11/11-I'm the one on the right.
    http://s1119.photobucket.com/albums/k630/pottoff2/

  9. #9
    Join Date
    Feb 2012
    Location
    NC
    Posts
    129
    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
    Scheduled for surgery with Dr. Lenke Oct. 2012
    53*T 71*L
    Surgery 10/05/2012 T4-pelvis
    Correction: looks perfect! Will find out how perfect at future appointments

  10. #10
    Join Date
    Jul 2012
    Posts
    63
    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.

  11. #11
    Join Date
    Jun 2011
    Location
    Southern CA
    Posts
    2,262
    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.
    Melissa

    Fused from C2 - sacrum 7/2011

    December 8, 2014 - Another Broken Rod Surgery

  12. #12
    Join Date
    Feb 2011
    Location
    Lilburn, GA
    Posts
    201

    Cost of surgery

    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
    50 years old!!!!!
    Wore Milwaulkee Brace 1976-77
    Original curve 36 degrees ( measured in the 70s)
    Advanced to 61 degrees 01/2011
    Surgery 07/11/2011
    Fused T1-L2 (curve now in the 20s!)

  13. #13
    Join Date
    May 2008
    Location
    Central NJ
    Posts
    1,956
    Get the best insurance you can. This is a very expensive surgery. It will be worth it over the long run.
    __________________________________________
    Debbe - 50 yrs old

    Milwalkee Brace 1976 - 79
    Told by Dr. my curve would never progress

    Surgery 10/15/08 in NYC by Dr. Michael Neuwirth
    Pre-Surgury Thorasic: 66 degrees
    Pre-Surgery Lumbar: 66 degrees

    Post-Surgery Thorasic: 34 degrees
    Post-Surgery Lumbar: 22 degrees

  14. #14
    Join Date
    Apr 2011
    Location
    Northern Virginia
    Posts
    213
    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.
    Discovered scoliosis when 15 years old.
    Wore Milwaulkee Brace for 1.5 years.
    Top curve 85 degrees, bottom curve 60 degrees

    Surgery completed August 23, 2011 (during an earthquake, can you believe that?)
    Dr. Charles Edwards, II
    The Spine Center at Mercy Hospital in Baltimore, MD
    Before and after xrays:
    http://www.valley-designs.com/myspine

  15. #15
    Join Date
    Mar 2010
    Posts
    2,764
    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.
    Be happy!
    We don't know what tomorrow brings,
    but we are alive today!

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