Cost of Implant

[rms0929]

Hey,
I just received the bill for my hospital stay for my implant, with one overnight stay. Keep in mind, this DOES NOT include any doctors bills.

$84,289.00

Really, I was shocked! Should I have been expecting this?

Thanks

[wolfpacker]

Is this what you personally be paying, or is insurance paying most of this? If they want you to pay all that then it is WAY too much as there are plenty of great surgeons who will do the implant surgery for under $20k out the door.

[Gt1956]

Are you saying that your insurance company was billed that?? I doubt that a hospital would do an elective surgery without it being prepaid by you or you have insurance coverage.
When I get a "copy" of what my insurance was billed. It normally has a fine print clause explaining that the insurance has negotiated a different price.
As explained. The "real" cost varies by state & local. But even in NYC, Eid's cash price is under $30k as far as I understand.
Bottom line in my opinion. Prices thrown around on statements are fairly always fake or seriously inflated for various reasons. I remember a reporter tried to find out the bottom line on a relatives surgery for a story. Basically impossible to tell what the insurance pays. All costs are considered business secrets that are almost impossible to crack.

[Gt1956]

A few days ago I went to Walmart to fill a prescription. Because I normally get this drug by mail order. I wanted a little buffer stash in case a refill went wrong. I asked the clerk what the "cash" price was. She replied it was about $200. Ouch! She suggested that I search GoodRx for a coupon. I stepped aside & did that. I quickly found a Walmart coupon code for around $25. So that is what I ended up paying for 30 pills. Mail order I get 90 pills through my insurance mail order for $7. It was worth it to me to have a small extra supply.
Lots of pricing games are played in our medical system.

[Waynetho]

A few days ago I went to Walmart to fill a prescription. Because I normally get this drug by mail order. I wanted a little buffer stash in case a refill went wrong. I asked the clerk what the "cash" price was. She replied it was about $200. Ouch! She suggested that I search GoodRx for a coupon. I stepped aside & did that. I quickly found a Walmart coupon code for around $25. So that is what I ended up paying for 30 pills. Mail order I get 90 pills through my insurance mail order for $7. It was worth it to me to have a small extra supply.
Lots of pricing games are played in our medical system.

My Truvada (PrEP to reduce risk of infection if exposed to HIV) has a cash price of $2,000.00 per month for 30 pills. GoodRx price was about $1,680.00 for 30 days. Insurance price through my employer was $75.00 per month locally. Between mail-order insurance and the Gilead payment assistance coupon, I get a 90 day supply from my mail-order pharmacy for free each quarter, a $6,000.00 value (if you can call that a value).

[rms0929]

This was not my bill, but it did say "insurance portion". I do have 2 insurances, and I know between the 2 they will probably cover all the cost, I was just shocked to see that amount.

[Waynetho]

This was not my bill, but it did say "insurance portion". I do have 2 insurances, and I know between the 2 they will probably cover all the cost, I was just shocked to see that amount.

The hospital billed my insurance $53,577.20, who paid $34,485.77. The hospital waived the remaining $19,091.43 as their insurance network discount.

[Gt1956]

Waynetho, the pricing logic can be really interesting. I bet that the $34k was allowed but a further discount had been negotiated. Insurance is strange. They'll pay more for an xray preformed in a hospital than a clinic. Cost of business is higher in the hospital so they'll pay a higher price. What they actually pay can depend on where the service is preformed.
I read a story on the price structure for the newest greatest hepatitis C medicine. The proposed price was very high. The logic went along the line that the "old" treatment cost x & took y time to work. The new drug worked better & did it in a lot less time. So they valued the time saved on top of the old drug & came up with a price. So you basically could paid full value for the time saved by the professionals that didn't have to treat you.
My own naive opinion is that most net $$ money paid for an implant runs close to the quoted cash prices. I've herad that even the medicare rate is in that neighborhood. Length of time in the operating room & if done in a hospital or a surgical center probably changes the cost to insurance companies also.
Good that you don't have to pay list on your medicine. Consumers have to play all of the angles.

[Txagq8]

Mine was done 12/31/19.

I was basically at cap for out of pocket for year 2019 (main reason I tried to get it done before New Year)

The hospital billed $53K. They took $15K.
The surgeon billed $1800. He got paid $1300 iirc.
Each anesthesiologist (there were two) billed $1305, together they got $190.
There was some other misc charges that brought the whole thing up to just over $17K.
I have an unpaid balance for out of pocket in the amount of $2.84.

So guys, if you’re trying to negotiate an out of pocket deal based on what negotiated prices between hospitals and insurance carriers are really like, $17K would be a good place to start.

[implant1959]

My hospital bill in December 2020 was 43,000 the contracted rate with insurance was 27,000. I am sure you will be surprised when you get EOB(explanation of benefits) from your insurance carrier. You might see if they have a website to check your account, I know mine shows up there way before they send it to me.