Announcement

Collapse
No announcement yet.

How Much Does the Surgery and Hospital Stay Cost?

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • 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!
    I am stronger than scoliosis, and won't let it rule my life!
    45 years old - diagnosed at age 7
    A/P surgery on March 5/7, 2013 - UCSF

  • #2
    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/

    Comment


    • #3
      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 Degen Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Sev 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 SCI T4,5 sec to PJK
      2015: Rev 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
      2021: Removal T1 screw & rod

      Comment


      • #4
        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 63, the new 64...
        Pre surgery curves T70,L70
        ALIF/PSA 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

        Comment


        • #5
          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?
          I am stronger than scoliosis, and won't let it rule my life!
          45 years old - diagnosed at age 7
          A/P surgery on March 5/7, 2013 - UCSF

          Comment


          • #6
            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 Degen Scoliosis @65, 25* T & 36* L w/ 11.2 cm coronal balance; T kyphosis 90*; Sev 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 SCI T4,5 sec to PJK
            2015: Rev 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
            2021: Removal T1 screw & rod

            Comment


            • #7
              Depends on the surgeon

              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

              Comment


              • #8
                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/

                Comment


                • #9
                  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

                  Comment


                  • #10
                    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.

                    Comment


                    • #11
                      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

                      April 21, 2020- another broken rod surgery

                      Comment


                      • #12
                        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!)

                        Comment


                        • #13
                          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

                          Comment


                          • #14
                            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

                            Comment


                            • #15
                              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!

                              Comment

                              Working...
                              X