Cost of Outpatient Surgery?

[calvert_biker]

Question...I am trying to find out how much I will have to pay out of pocket for an outpatient surgery in a month or so. I have been *so* frustrated with trying to find this information, it truly makes me understand what a disaster the health care system is!

That ranting and raving aside, here's what I've done so far:
1) Called my insurance provider, who can only give me the details on what in-network payments are ($250 deductible, after which they will pay the next 90%)...but they cannot tell me anything more than that, or what the contracted rate is for this particular procedure.

2) Called the Business Office of the hospital (George University Hospital in DC), and they say that they cannot tell me what the cost will be...the direct quote, "You will find out what you owe after we submit the bill to the insurance provider, after which you will get a bill for what you owe."

So I'm in a catch-22, the surgery is one I should probably take care of, it's really not optional, but I could be hit with a $1,000 bill, a $10,000 bill, or $100,000 bill (probably not likely as the procedure will not be $1M, but still!)

Does anyone have any advice about other resources or processes I should pursue to understand what my surgery might cost?

Thanks in advance...

 

[Cowgirl]

What kind of surgery? :shrug:

I had gallbladder surgery 2 years ago and did not have insurance. My bill from the surgeon was $1750, my bill from the anesthesiologist was $400 (cut in half for me since I didn't have insurance ), and the hospital bill was around $6500 give or take.

 

[wineo]

They can't give an quote, depends on all you use, how many sponges, sutures, etc,.How much ansth, meds, iv drips. I would think that if it is a procedure your insur covers, that you won't be respon for much. Hubbys surgery for hernia cost 60.00 out of pocket, plus pain meds for after.

Don't put off a surgery that is needed. You can always make payments.

 

[Cowgirl]

You can always make payments.

 

[calvert_biker]

Thanks for the quick replies - I am not surprised that they can't give me an EXACT quote, but I'm shocked they can't tell me something along the lines of 75% of the surgeries done of this nature cost between $X and $Y.

The surgery is to remove a non-cancerous lump that has grown slightly over the past 5 years. I agree that I can't really put a price on peace of mind and my health, but I am surprised at how difficult this data point has been to gather!! I appreciate the details from your surgery a few years ago, that makes me feel better as I now know I am probably looking at a total bill of $10k or so, not $50k.

I am going down to GWU next week and am going to visit the business office in person...

 

[Cowgirl]

Thanks for the quick replies - I am not surprised that they can't give me an EXACT quote, but I'm shocked they can't tell me something along the lines of 75% of the surgeries done of this nature cost between $X and $Y.

The surgery is to remove a non-cancerous lump that has grown slightly over the past 5 years. I agree that I can't really put a price on peace of mind and my health, but I am surprised at how difficult this data point has been to gather!! I appreciate the details from your surgery a few years ago, that makes me feel better as I now know I am probably looking at a total bill of $10k or so, not $50k.

I am going down to GWU next week and am going to visit the business office in person...

Good luck! The bills will probably always be higher than expected. I think they charged me $250 to let me wake up and eat a cracker and drink some ginger ale in their recovery room.

 

[calvert_biker]

Good luck! The bills will probably always be higher than expected. I think they charged me $250 to let me wake up and eat a cracker and drink some ginger ale in their recovery room.

That must have been an awesome cracker and soda Ridiculous! I will have to pack my own

 

[bluesmom31]

I am a medical biller and unfortunately it is very hard to tell what your responsibility will be. Contact the provider performing the surgery and ask for the CPT codes. These are the codes that the insurance uses to process your claims for payments. Once you have the CPT codes, you can call your insurance and ask what are the allowables for those specific CPT codes. Assuming the physician you selected participates with your insurance, you can't be charged more than the allowable. If your insurance pays 90% then this means they will pay 90% of the allowable and you will be responsible for the difference. Make sure that the physician pre-certs your procedure with your insurance company. Keep in mind that you will probably get three bills: one from the physician, one from the facility, and one for the anesthesiologist. In order to know exactly what your responsibility would be you would have to get all the CPT codes from all of the people involved! Still it isnt exact! Good luck with the procedure.

 

[calvert_biker]

I am a medical biller and unfortunately it is very hard to tell what your responsibility will be. Contact the provider performing the surgery and ask for the CPT codes. These are the codes that the insurance uses to process your claims for payments. Once you have the CPT codes, you can call your insurance and ask what are the allowables for those specific CPT codes.

Bluesmom, thanks for the suggestion - I called the hospital and pretended that I did not have insurance (because last time I chatted with the hospital, they said they won't give out any information to people who have insurance...totally not legit i am sure...but oh well), asked for the CPT codes, did some research online, and called my insurance company...and I think I have a somewhat reasonable estimate of $10 - $15k - of which my insurance should cover over 95% - thank god for insurance.

Thanks to everyone for the suggestions!!