What my ALIF Fusion on L4-S1 cost....broken down, interesting figures

[Greg]

Before I had my 2 level ALIF or did anything medically other than a regular doctor visit I have always tried searching the internet to find out how much it might cost me. I know finding medical costs is a challenging task as they aren't always the same and can vary greatly due to location, insurance, level of work done etc. So it seems that nobody really wants to post the costs online. I have received all of my bills relating to my ALFI on L4-S1 (what fun that was ) and had to file them all and put them into a spreadsheet in order for me to stay on top of them and not get sent to collections. Its not like I owe an arm and a leg but being out of work recovering puts a strain on the finances and I'm not fortunate enough to just "write the check"

Since I have a nice spreadsheet with all the costs and had a hell of a time finding out what it cost beforehand so I decided to take this oppurtunity to share this information with you all so anyone looking into getting this procedure can get a general idea of the costs. Keep in mind the total amount can vary greatly depending on a lot of things especially the length of hospital stay which my total billed amount (what was billed, not what was allowed) accounted for 73% of the entire cost $93,000 and 83% of total allowable $59,000 and actual cost So that can make a huge difference as my stay was 2.5 days and 2 nights. By the time the hospital submitted the bill to my insurance I had already hit my out-of-pocket cap for the year (Thank God for that) so I havent received a bill and dont know the breakdown of charges. I know my insurance company BCBS wishes they could drop me; I've hit my Out-Of-Pocket Cap 3 years in a row and they've spent close to $150,000 in those 3 years All the line items for the bill I read online said "SURGERY" so I dont know whats what

I dont think I can copy and paste the excel sheet so I'll just give you the summary/highlights. I tried to attach the spreadsheet for your viewing pleasure but am having some technical difficulties. I'm sure it will be attached soon when Justin can get some free time to assist....I will update you all when this happens. I did manage to take a screenshot of the spreadsheet and copy it into "Paint" so I can attach it as a picture. Just click on the image if you need to enlarge it.



Total Amount Billed: $127,982
Total Amount Allowed: $70,375 (53.54%)
Discount: $57,607 and the sad part is if you didn’t have insurance you would still be billed full price

“Summarized Breakdown”
Hospital Billed $93,487 but only allowed $58.897 (83.7% of total cost)
Surgeon Billed $25,396 but only allowed $5,458 (7.8% of total cost)
Anesthesiologist Billed $2,150 but only allowed $1,422 (2% of total cost)
Back Brace Billed $1,246 but only allowed $823 (now that’s a pricey brace)

Here’s the real kicker: The bone growth stimulator (Orthofix) billed $4,995 and actually allowed $3,329 (4.7% of total cost) The Bone Growth Stimulator cost more than 2 times the cost of the Anesthesiologist and 60% of what the surgeon was paid. But from all the research I did and studies I found on the bone growth stimulator it is worth its weight in gold. With a minimum of 90% success rate of aiding fusion (even with smokers) you can’t beat it. They even guarantee you will fuse and if you don’t fuse and wore the device the required 2 hours a day for 90% of the time which is 3-4 months they will refund the cost of the device.

Overall I think the costs were pretty fair and $30,000 less than expected. I estimated from my research to be between $60,000-$100,000 and it ended up being $70,000. Although I feel like the surgeon should have received more than the $5,400 they received. Out of the $5,400 I believe only $2,000 was for the doctor doing the surgery....although I guess making $800 an hour isn't that bad I think the surgeon who did my shoulder surgery made much more than that (but can't confirm because online access to insurance is closed now) but I'm not going to be foolish and complain about not being billed enough HOPE THIS HELPS SOMEBODY....it sure did take a while to put together

[Jack-of-all-trades]

I had to request an itemized bill on two different occasions. What I found was a lot of stuff on there ($thousands) that I never received. Probably originated from standing orders, maybe prn, and the recorder just assumed I got the stuff. The hospital did give me credit for $3-400.00 but I'm not finished with them yet. They sent me a check for $340.00 a few weeks back after I asked for it. They had been holding this money since October of '09. My surgery was in Dec '09. As of last month, we were at $0.00 balance, now this month it is $600.00 and change from my surgery in December. No one can tell me what it is for. I told them to have the supervisor call me. I've listened to enough elevator music.

[KBear]

This is the first year in 5 years that I have not reached my deductible and out of pocket costs.... I haven't even had to do anything toward the deductible, just regular office visits!!! It feels great to have that burden gone.

[Greg]

I had to request an itemized bill on two different occasions. What I found was a lot of stuff on there ($thousands) that I never received. Probably originated from standing orders, maybe prn, and the recorder just assumed I got the stuff. The hospital did give me credit for $3-400.00 but I'm not finished with them yet. They sent me a check for $340.00 a few weeks back after I asked for it. They had been holding this money since October of '09. My surgery was in Dec '09. As of last month, we were at $0.00 balance, now this month it is $600.00 and change from my surgery in December. No one can tell me what it is for. I told them to have the supervisor call me. I've listened to enough elevator music.

Thats one thing I highly dislike (I try to avoid using the word "hate"....such a strong word) about the local hospital that I've been to so many times. They dont send you an itemized bill unless you ask for it. All you get is a bill that says ER/Ambulatory Service, date of service, amount insurance paid and amount you owe....they don't tell you squat about what you received for the money. And hospitals are notorious for making mistakes on hospital bills; billing you for treatment and supplies you didn't receive or duplicate line items are very common. And our local hospital makes you a new account number everytime you go there so you if you went to the ER 4 times in one year and havent paid all the bills you would have 4 different bills on 4 accounts with 4 different balances and 4 bills you have to pay something on every month to keep them happy. Why they dont just give you one bill with one accumulated balance we will never know. The answer to that question is probably hiding with the answer as to why you have to ask for an itemized bill and cant get it from the start. The only way to get a cumulative balance is to let it go to collections. Which I have done (because as long as you pay them they dont report it) so I can pay on one balance every month not 4 different balances every month....I really shouldn't have to do that....it's just sad

But since the hospital bill for my surgery was 100% paid for due to me meeting my Out-Of-Pocket cap I have no need to go through and scrutinize the line items. If I find mistakes its only going to help the insurance company and they have toyed with and screwed me for years so I have no desire to help them. I should have had this surgery a year ago but because I had already hit my Out-Of-Pocket cap in October they wanted to hold me off for a few months until the next year giving me bs excuses but not telling me that was the case so of course the next year comes around and I've already lost all my appeals so I had to accept the fact they would never pay for the standard care one would receive for just 1 of the 3 problems I had going on So they prolonged my pain, agony, stress, depress, took away my will to live, made me lose hope and give up on my fight.....so I dont want to help them out at all. Unless if I audited the hospital bill, found mistakes, got them to acknowledge them and correct them and I received the reimbursement check....then I would do it. Is that possible or would they onlyreimburse the insurance company since all payments from them??? I'm used to auditing the bills but like I said if it only benefits BCBS than I dont want to do it! Sorry to rant about the insurance but they destroyed my life for quite a while so except for me having an awesome insurance plan I just dont like them

This is the first year in 5 years that I have not reached my deductible and out of pocket costs.... I haven't even had to do anything toward the deductible, just regular office visits!!! It feels great to have that burden gone.

Nice one Kathy....that's a problem I would love to have.....just regular $25 office visits would be a nice expense to deal with instead of paying for overcharged doctor bills. I am so happy for you! I guess you wont be saying the same thing next year But I'll bet my salary that you're going to be more than happy to have baby bills because that means you have added another member to your family. I can't wait for you.....that's going to be so exciting. Are you crossing fingers for a boy or a girl? Do you have just girls now or????

[Jack-of-all-trades]

Greg,

I too had met my out of pocket except for $1,800.00+- that I paid on the day of admission for surgery. Our insurance changed January 1st of 2010. The hospital was told to make sure the bill was sent to the previous insurance company that was in effect up to December 31st 2009. They did not and sent it to the new company along with a string of bills spread out over months. Since the new insurance company didn't pay, the hospital sent me the bill for $88,000.00+- dollars with the usual threats to turn it over to a collection agency. I had to call them, listen to numerous options and music and thought it was straighten out. Part of what makes even the itemized bills so confusing is that bills for the surgeon and staff, the physical structure, i.e. bed, nurses, food, etc. and the pathology lab are billed separately. Thing is they have no problem taking money paid that shows up as a credit from say the physician account to pay on the hospital account. None of the credits from money I pay or transfers shows up on an itemized bill sent to me.

I don't see why in my case since I paid $1,800.00 on admission to supposedly meet remaining deductibles that the one mistake they gave partial credit for could not come to me instead of the insurance company. I was billed $148.80+- a day for O2 for every day I was an inpatient not counting what was billed as surgical supplies. The hospital said they gave"partial credit" to the insurance company of $200.00.

This particular hospital was instrumental in starting this insurance company years a go. I would love to know if they still own all or part of the insurance company. This is a non-profit hospital if you can believe that. They pay no property taxes, own a hotel in town and are buying up physician practices right and left from physicians getting frustrated with our reimbursement system. The doctors end up working like factory workers on an assembly line. My supervisor in a clinic in the last place I worked as a PA (one owned by a different hospital chain) made this "ching-ching" sound like an old cash register. This was my cue that I had better run up the bill, especially effective for workers comp cases and for me to schedule useless follow-ups.

Sorry about the sermon from the soapbox but I get fired up sometimes over what seems like corruption. It is quite frustrating.

[KanRunMo]

Greg,
Thank you so much for the spreadsheet of your surgery costs. I know it was a huge lot of work because I've tried to do this with my medical bills and got so confused I kind of gave up. It is a great help to have some idea of what these surgeries cost so again, Thanks.

[Susanna]

Greg,

I have had your exact experience with the multiple hospital bills. Then when I mad the payment of "my portion" they posted it to all one account, instead of posting it to each of the accounts, as I wrote and instructed them. I then received all sorts of horrible threatening letters saying that they were going to turn me over to collections. The funny thing is, they were suppose to tie all of the accounts together so that I only had to make one payment. I often say about hospitals and insurance companies, that the left hand doesn't know what the right hand is doing.

We had so many problems with our insurance company covering our things correctly that we had to go to the state and get a representative to assign someone to be in charge of each of our claims to make sure they are handled correctly. Things still get messed up, but she straightens them out.

Unfortunately, she can't make the insurance company do things that the FDA says is safe. I wish there was a way that they could be sued for not providing care that the FDA says is approved!

Susanna

[Greg]

Greg,

I have had your exact experience with the multiple hospital bills. Then when I mad the payment of "my portion" they posted it to all one account, instead of posting it to each of the accounts, as I wrote and instructed them. I then received all sorts of horrible threatening letters saying that they were going to turn me over to collections. The funny thing is, they were suppose to tie all of the accounts together so that I only had to make one payment. I often say about hospitals and insurance companies, that the left hand doesn't know what the right hand is doing.

We had so many problems with our insurance company covering our things correctly that we had to go to the state and get a representative to assign someone to be in charge of each of our claims to make sure they are handled correctly. Things still get messed up, but she straightens them out.

Unfortunately, she can't make the insurance company do things that the FDA says is safe. I wish there was a way that they could be sued for not providing care that the FDA says is approved!

Susanna

Well....she can and there are ways. Usually the insurance commisioner or agent dont get lucky (maybe because they didnt try hard enough) but thats where a perfectly written well researched and documented appeal comes in handy. As for suing the insurance company (I wish I had my personal laptop with me as I have many court cases where ins company was sued for ADR denial and forced to provide coverage) if the way or reason they deny someone is unethical, done not according to the policy and procedures and you can prove that your coverage allows for it than you can sue them for denying coverage. And sometimes they decide to settle before you even go to court and cover you because it could cost them more for the attorneys and studies for court then the surgery itself. But if you did this you would need to have an enormous amount of documentation to prove that they have been covering it, its better for you than what they are offering, its the only thing that will help you, and it helps throwing in the fact that ADR could cost them half as much money as ADR. Best of luck to you!

[Susanna]

Well....she can and there are ways. Usually the insurance commissioner or agent don't get lucky (maybe because they didn't try hard enough) but thats where a perfectly written well researched and documented appeal comes in handy. As for suing the insurance company if the way or reason they deny someone is unethical, done not according to the policy and procedures and you can prove that your coverage allows for it

Well, I am probably SOL on two counts here. First our insurance is a "self pay" insurance (I think that's what it's called) and so the insurance commission has no bearing on what they do. The only reason I got help with my bills when everything was so messed up, was because the insurance commission felt so bad for me, that they sent my stuff to the state. They helped me. But the state won't get involved with making the insurance company "do" anything when it comes to fulfilling their policy. I did ask them. To me it's all very shady.

You mentioned one thing that I thought was interesting though. If the FDA has approved something, and yet the insurance company's say, "there is not enough proof that this is better than the standard way of doing things" So we aren't going to cover it. How do you get them to cover it. It is obviously a "not covered" item in the policy, though it should be. That is what gets me.

If drives me crazy, it's just like the stupid bank that wouldn't accept a bid on my house because it was $2000 short of what they wanted. If the new procedure can be done with a shorter hospital stay, a shorter recovery for the patient, which means less pain meds, which means the patient goes to work sooner, Then even if the eventual out come is the same, why not cover it? It seems to me that in the long run it will save the Insurance company more money. But they can't see it. Just like the bank can't see that by giving in to $2000 will save them money by not having to foreclose on my house, and auction it off, where they probably won't get near what that person was paying. Just really frustrates me. And I think that the people at the doctors office have their letters and when I said, can I submit a letter? They were like," lets just wait and see what happens first."

Ok, off my soap box. Just drives me crazy that people don't look past the forest to see the tree branches!!

[trkdoc714]

The cost of your surgery was $70,375? Did they cover any days of hospitalization after surgery?

The cost of the ADR surgery I had was 28,400 euros. The exchange rate at the time converted it to around $38,000. Both ADR and ALIF are similar surgeries (other than the hardware). It amazes me that health care in the US is so high. It makes one wonder how legitimate the insurance industry's numbers are .