Insane surgery cost

[cgdirector]

I realize this may be a fairly personal question. This is more to satisfy my curiosity...... I pose this question to those who underwent IPP surgery and who had insurance. When you received your bill, what was the general overall cost for the implant surgery? Hospital + urologist+ anesthesia. The reason I am asking is that I received my bill last week and about hit the floor. The cost of the surgery was $74,000. The insurance company paid $69,000, wrote off $5,000 and I owe $1,000. It's not the out of pocket/patient responsibility that disturbs me. It's the fact that the implant cost more than most other people entire surgery. (accounted for almost $50,000 of the cost). I have BCBS and live near coastal NC, not NYC or LA. I am in healthcare and are aware of the "general" regional costs of other surgeries like hip/knee/shoulder replacements, surgical fracture fixation with hardware, etc. and none of them cost what my implant surgery did.

I know from reading these boards that people can go to NYC and pay roughly $35,000 out of pocket for the surgery. I understand about cash price versus insurance but if Dr. Eid can do it for $35-40K, surely the implant didn't cost him $50K.

[medhatg]

I realize this may be a fairly personal question. This is more to satisfy my curiosity...... I pose this question to those who underwent IPP surgery and who had insurance. When you received your bill, what was the general overall cost for the implant surgery? Hospital + urologist+ anesthesia. The reason I am asking is that I received my bill last week and about hit the floor. The cost of the surgery was $74,000. The insurance company paid $69,000, wrote off $5,000 and I owe $1,000. It's not the out of pocket/patient responsibility that disturbs me. It's the fact that the implant cost more than most other people entire surgery. (accounted for almost $50,000 of the cost). I have BCBS and live near coastal NC, not NYC or LA. I am in healthcare and are aware of the "general" regional costs of other surgeries like hip/knee/shoulder replacements, surgical fracture fixation with hardware, etc. and none of them cost what my implant surgery did.

I know from reading these boards that people can go to NYC and pay roughly $35,000 out of pocket for the surgery. I understand about cash price versus insurance but if Dr. Eid can do it for $35-40K, surely the implant didn't cost him $50K.

I had the revision surgery as a cash-patient in California. The final bill was in the 70k range, then like 70% discount and write-offs brought it to 10K + $2,300 for the surgeon. The IPP itself was covered under warranty from AMS.

[cgdirector]

I realize this may be a fairly personal question. This is more to satisfy my curiosity...... I pose this question to those who underwent IPP surgery and who had insurance. When you received your bill, what was the general overall cost for the implant surgery? Hospital + urologist+ anesthesia. The reason I am asking is that I received my bill last week and about hit the floor. The cost of the surgery was $74,000. The insurance company paid $69,000, wrote off $5,000 and I owe $1,000. It's not the out of pocket/patient responsibility that disturbs me. It's the fact that the implant cost more than most other people entire surgery. (accounted for almost $50,000 of the cost). I have BCBS and live near coastal NC, not NYC or LA. I am in healthcare and are aware of the "general" regional costs of other surgeries like hip/knee/shoulder replacements, surgical fracture fixation with hardware, etc. and none of them cost what my implant surgery did.

I know from reading these boards that people can go to NYC and pay roughly $35,000 out of pocket for the surgery. I understand about cash price versus insurance but if Dr. Eid can do it for $35-40K, surely the implant didn't cost him $50K.

I had the revision surgery as a cash-patient in California. The final bill was in the 70k range, then like 70% discount and write-offs brought it to 10K + $2,300 for the surgeon. The IPP itself was covered under warranty from AMS.

Medical costs and reimbursement vary by region. If I lived in CA, i would not have blinked an eye at $70K....

[newbie443]

When I had my surgery almost 3 years ago I was self pay and basically paid with 3 checks. Each approx. 1/3 the total cost of 24K. One of those approx. 8k checks was for the device. But I had the LGX so cost will vary a bit.

I can go to my BCBS web site and see EOB and that is vastly different from the bills I receive from the providers. That not only tells you what BCBS paid the providers but lets you know what your actual responsibility is.

[cgdirector]

When I had my surgery almost 3 years ago I was self pay and basically paid with 3 checks. Each approx. 1/3 the total cost of 24K. One of those approx. 8k checks was for the device. But I had the LGX so cost will vary a bit.

I can go to my BCBS web site and see EOB and that is vastly different from the bills I receive from the providers. That not only tells you what BCBS paid the providers but lets you know what your actual responsibility is.

That's the issue. It was 70K AFTER the write-offs. As a medical clinic owner, I totally understand about UCR charges, contracted rates, write-offs, OOP costs, etc. Again, it's just shocking that my insurance paid almost 50K for a Coloplast Titan One Touch inflatable penile implant when a replacement mitral valve for the heart doesn't usually cost that much lol....

[Waynetho]

I had mine done on 10/28/19 by a urologist/surgeon in Texas (not exactly high volume as he also has a full practice). The hospital was Baylor Scott & White in Frisco TX, my insurance is BCBS of Illinois and total billed to insurance was $62,892.50 and Blue Cross paid out after contractual reductions, $37,147.43. Of that I paid exactly $0.00 because I had already met my $3,000.00 deductible for a previous colonoscopy, unrelated hospital stay and UroLift procedures during the plan year.

[FMLFML85]

.

[implant1959]

I had surgery last month.
Hospital Bill 43,155 Insurance Allowed 27,725
Surgeon 4.259 Insurance Allowed 1,443
Anesthesia 1,190 Insurance Allowed 924

Total Billed 48,604 Allowed 30,092 so they paid about 62% of billed charges. My portion was under 600 because of meeting my maximum out of pocket. That's why I did it in 2020.

I had my appendix out earlier this year and they only paid 27% of billed charges.

So it doesn't have to make sense. I work in healthcare and billing and reimbursement don't have to make sense.
I am guessing there was a bigger write off on the appendix because that is done more often then an IPP. Also the same insurance company may pay different at different hospitals because of the contracted rates.
But I don't think you can compare to heart valve unless you know what the contracted rates are for specific hospital and insurance.

[newbie443]

I would hope that it was just a mistake and get sorted out soon.

[implant1959]

I know from reading these boards that people can go to NYC and pay roughly $35,000 out of pocket for the surgery. I understand about cash price versus insurance but if Dr. Eid can do it for $35-40K, surely the implant didn't cost him $50K.

You have to realize that the Operating Room is one of the few areas of the hospital that produces a profit and has to support the areas that don't. So an outpatient surgery center can do surgery cheaper because they aren't supporting other areas that are losing money. Insurance/Medicare reimbursement can be different between a hospital and a strict outpatient center.
So Dr Eid can offer a cost that will provide him with profit, because he doesn't have to worry about losing money in other areas. Also if you have insurance his pricing might be much different, and then have contractual adjustments.
You could go insane trying to understand health care pricing, contractual rates, self pay discounts, etc.