Anyone know what is cost of 3 piece if self pay

[Gt1956]

I agree with your assessment...on implant pricing.
If we factor in the high volume surgeons in USA..how much does one factor for an extremely well skilled surgeon?

I'm a frugal guy, so bear that in mind. My most heard of price is around $19,000USD. I've seen prices thrown around of +- around $2,000USD. A lot really depends on the city/area where your doctor is located. There is a good chance that the lowest surgery price might be in a city that is difficult to fly to.
My advice, pick a few cities that you can either fly to or you are comfortable driving to. Then make a list of a few surgeons near those cities. Next, make up a nice polite email to send to your listed surgeons. Explain your circumstance & health conditions. Towards the end gently ask what you could expect to pay for the surgery. Warning, I've found that surprisingly many doctors are not well versed on what they charge. Yes, that is surprising.
I hope that helps you get a start on your search.

[oldbeek]

Thanks

In Toronto there are surgeons who have the patient pay for the 3 piece device only. Hospital and surgeons etc are government funded.

I guess I am trying to find out the approximate price of a 3 piece inflatable.

I had insurance and medicare. The device was listed as a line item. Supplies, implant, $12,670. Medicare paid the full price of $12,670.00. There was about $3,000 of additional supplies. The Dr billed $5,970 and medicare payed $5,790 with insurance paying the rest.. Anesthesia was $4,000. Hospital cost ? around $10,000 To put things in prospective, the hospital billed $47,000 and accepted $7,209 from medicare for the implant stay.

[RayChez]

oldbeek is correct. What the hospitals, doctors etc etc charge does not mean the insurance is going to pay them what they charge. These hospitals and surgeons are under contract with medicare or medicare advantage companies and they will accept much less then what the original bill would be. But I do know that medical in general has gone sky high in the last four decades. I do not know what my last revision was, but medicare advantage paid the whole amount.

[Txagq8]

I asked the question before having it done. “My insurance said they will pay, but if they change their mind and don’t, what’s it going to cost?” I also was looking at “if we don’t get this done in 2019, and. In 2020 my deductive starts over and I have to make a 20% co-payment, his much will it be?”

At Baylor/Scott&White in Temple, Texas I was told that the overall total that would. Be billed to insurance carrier was around $42,000. That being said, they would take the insurance company negotiated amounts and I would ultimately be paying 20% on between 20,000 and 30,000. So I’m guessing a self pay cost there would be about $25K.

I ended up having it done in Austin, where the self pay price (depending on if it’s done at hospital or ambulatory outpatient surgery facility) is in the $18K-$20K range. Thus isn’t a high volume doc like Eid or Kramer, but it is the high volume doc of greater Austin, Texas.

My good news is not just that I’m healing ok, and the implant works.....I called billing yesterday wondering why I hadn’t seen a bill after a month and they said your insurance paid it in full within 10 days of us submitting the claim.” Amen.

[Waynetho]

Txagq8, the way insurance usually works is that you would only be responsible for deductible and maximum out-of-pocket even if the 20% co-pay is in the tens of thousands. They set the out-of-pocket for a reason. Once I have accrued over 3000.00 in medical costs, my expenses are capped at 3000.00 for the year and everything else, as long as it is a covered expense, is covered in full. The only exception would be if I met my $3000.00 in-network OoP max but had services in an OUT OF NETWORK facility (which my OoP max is $6000.00 for out of network). I would be responsible for all 40% out-of network co-pay for the remaining services, until the remaining $3000.00 was paid out of pocket (total of $6000.00 between in and out of network charges).

[indusvalley]

Dr Kramer is $24,000 if you are self pay without using insurance.

[Biker60]

Dr mentioned on board in Baltimore 24k
Dr mentioned in NY 30K

My surgery was 1/2 severe PD. Plication and implants. Hospital and Dr 93K. Aetna contractually rate was 43K. Hospital coded as Ed so now I am billed 43K from Hospital since exclusion does not pay for implants. Appealing and resubmit with PD as Dx. Business office suggested settle for 17K. Medicare rate is 17K.

[Agfa13]

Not sure who this will help, but doing my taxes here, and needed to look up information for 2019.
My initial implant, which was a 3-piece, was $37K, United Health Care paid $16K, because I had insurance. I paid my out of pocket, which was $6,500k.
2nd op, by Dr. Kramer, was $40K (infection surgery to take out 3-piece), UHC paid $14K, again, because I had insurance.
All-in-all, my price was $6,500k for both surgeries. Have to pay the $6,500k for 2020 too for the 3-piece.

[Weazer]

My insurance will not cover an implant so I am self pay for my revision. These are the costs I have been quoted, I don't have my notes in front of me but these are all close. It remains to be seen if Coloplast will give me a replacement. The outpatient surgery is 14,053 plus I elected to spend the night in the hospital, another 1,350. Doctor's fee is 850 and anesthesia is about 1,900.

Hope this helps.

[Agfa13]

Damn! That is really low for out of pocket:). Did you negotiate that price?