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Cost of knee replacement surgery

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dovcar2000

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Hi Everyone...

This is a question that I have wondered about for a long time.....DO YOU PAY FOR THIS TYPE OF SURGERY OUT OF YOUR OWN POCKET??

In Canada we may pick our surgeon but mainly we have a small selection to choose from and you may have up to a year's waiting time...so you go with who ever will get you in sooner.
I was lucky as we have an excellent one right in our own home town.
Next the cost is covered for the surgery and the physio at the hospital by our Government....

I am just curious as how the system works in other places..
Thanks Carol
 
We pay nothing in the UK, except our National Insurance contributions from wages/salary when we are in employment. Needless to say, a lifetime's NI contributions for your average worker barely covers the cost of routine health care for that individual's life, never mind things like joint replacements, treatment and intensive care for a heart attack etc. That all comes from the goverment meaning it all comes from our taxes from income and purchasing, etc., etc.

Most UK residents have no idea what a knee replacement prosthesis costs much less the entire operation!
 
My health insurance paid about 80K on my with my out of pocket about 800 dollars only because I had met my deductible for the year. Otherwise, my share would have been about 3800.
 
Just an additional bit of info on the Ontario Health Insurance Plan for TKR's. I live in Southern Ontario in the Greater Toronto area and was able to pick my surgeon at a hospital in a neighboring city. His wait time was 2 to 3 months and he gave me the option of July, Aug or Sep when I went to him in May. I understand the Ontario government has selected knee and hip joint replacements as a priority. If hospitals can reduce their wait time, they get extra funds. Not so for other replacements such as elbows & shoulders where the wait is much longer.

Physio therapy is also covered outside of the hospital provided you go to an OHIP funded clinic which are few and far between. Also the OHIP plan pays the clinic very little for each visit (I've read it is $12.20 per visit) so as I've unfortunately found out, in most OHIP clinics the standard of treatment is low. They hire kinesiologists, several who work under the direction of a single registered physiotherapist. You can go to private clinics if you have supplemental insurance or you can pay for the treatment. A two tier medical system but the government would deny that.

The problems I am having with flexion after 6+ months have been blamed on OHIP funded PT by my OS. I started to use a private clinic at 6 weeks but the OS says it was too late then.

As Carol (Dovcar2000) mentioned there is no supplemental cost to the patient for the OS and at the hospital unless you want a private or semi private room, want the use of a phone or your own TV.

As Jo mentioned about the UK, most Canadians have no idea what the true cost of a replacement or any other medical procedure costs.

Vern
 
Sometimes there's an advantage to being over 65... I didn't pay a cent for my TKR. Well, I do pay for supplemental health insurance. That and medicare paid everything, including my PT.
Sandy
 
Well that is a lot of different information...

I really had no idea the cost involved as I have everything covered between the semi-private room to the hospital care by OHIP here in Ontario.
Now if I had wanted outside physio then I would have had to pay for it so I choose to take Physio at our local hospital ..twice a week.

Sandy are saying that if over 65 in the States it is free then??

Gosh if you had no coverage...then you would be looking at around $100.00---that is one pile of money.

Thanks for all of your answers....as |I have wondered this for several months now...hugs Carol
 
I am on a Blue Cross plan where you do pick your own providers. The hospital billed Blue Cross about 80K, my share was $750.00. My docs have a contract with Blue Cross and accept what they have negotiated. All my visits from pre -op to the many post-op (even my unscheduled ones) are all included so I have not had to pay the surgeon's at all.

Physical Therapy depends on where you go. I have a pt that my spine doc and I love. He is not on the Blue Cross plan so my co-payments are expensive. ABout $25 per visit.

Judy
 
I also live in Ontario and was given a choice for when I wanted surgery, in Missassauga. Our private insurance paid 80% of semi private room and all the cost of op, or I would still be hobbling around!! PT was covered 80% for $1000 per year, then I had to pay, I was almost a year with PT. I am out about $2000 this year for TKR related medical expenses. I am trying to see if I can claim some back in taxes now. You have to pay for crutches and casts etc here unless you have private insurance.

The health care is far superior in Ontario compared to when I lived in England. They treat you as a person here not like cattle for one thing!! You always see the surgeon who did the op (no Housemen or Resident Doctors), the big chief himself. My surgeon knows me if I see him in the street!!
 
Hi Carol - here in Australia I saw my OS privately and he operated on me in a public hospital, as a private patient. Between my private health fund and our Medicare system - my entire bill was AUS$15,500 of which I only paid AUS$1500. My hip prosthesis was AUS$8900 and it cost me nothing - fully covered! However, I intend to have my RTHR done in a private hospital because I found myself the only female in a 6 bed ward which made privacy a bit of an issue - and sleeping was a non-event being surrounded by snorers! LOL

Peta
 
Hi Peta....you mean to tell me they put you in the same room as the guys................whoa....that is a little rough to take.
I don't blame you for going to a private hospital ........my gosh you are at your worst at this time and privacy is so important...
Yikes!!!
Good luck on your next operation...hugs Carol
 
However, I intend to have my RTHR done in a private hospital because I found myself the only female in a 6 bed ward which made privacy a bit of an issue - and sleeping was a non-event being surrounded by snorers! LOL

Peta

Yikes, Peta! You mean its standard practice to put men and women together in the same room? I think it would be bad enough to be in a big ward like that, much less having men in there. How did you manage??!!!

I'm in Washington state, and my hubby's insurance coverage is good. For my LTKR we only paid about $1,600 out of pocket, and most of that was just the family deductible. It'll be similar for my RTKR. And the major hospitals in the Seattle area seem to only have private rooms--for which I am VERY grateful! I briefly had to share a room this last time, but as soon as another room opened up, they moved me--apparently standard policy until the new hospital is finished (it has all private rooms).

Weezy
 
Hi Sue....you can claim your medical expenses on your Income Tax...I did.
Also when I was in the hospital last week and the surgeon put my broken foot in an air cast...I did not pay a cent!!
I thought I would have too but I just walked out with it on my foot. I wonder if no charge came because the surgeon ordered it??
Thank gosh most of our cost are covered here in Canada....I would hate to have had to pay for it...hugs Carol
 
We have mixed wards in the UK. Started it in 1980, much to everyone's disgust! However, the vast majority of our hospitals have wards split into 6/8 bed cubicles so the sexes have been separated again! As a matter of fact, it is in the current government's manifesto to do away with mixed sex wards as soon as they can.

And pigs might fly!
 
Dovcar, anyone 65 years old or older, can elect to have medicare as their primary insurance. If someone is still working and their work covers their insurance, they can elect to wait until some later date to go on medicare. If that 65 year old on medicare sees a physician, that physician sends medicare a dollar amount "he/she" feels their service is worth. Medicare in turn pays something like 80-85% of the dollar amount "they" think the service is worth. If the 65 year old has elected to pay for supplemental insurance, their supplemental insurance pays the physician the remainder of the medicare amount. And, the patient pays no out-of-pocket expense. If the 65 year old doesn't have supplemental insurance, he/she pays the remainder that medicare doesn't pay.
Sandy
 
WOW! I think Americans who are rabidly in favor of nationalized health care need to read posts on this forum!

I'm a "hippie," not over 65, and my Oct 30 replacement surgery (hospital only, not surgeon, anesthesiologist, or other doc fees), was just over $57,000. Insurance company knocked that down to just under $20K (per contract with provider), which is what hospital was paid. My annual deductible is $1500, so that was the limit of my out-of-pocket expenses.

Perhaps more importantly, I was able to make my initial appointment to see my OS within 3 weeks, and when I went to see him, we scheduled my surgery right then and there on the day I wanted.

We may gripe about our system & spiraling costs, but I can't help but see a lot of advantages versus government bureaucracy!
 
Yes I must admit I got the shock of my life when I realised I was the only female in the ward! Mind you - in the initial stages I could have cared less who I was "sleeping" with!! It was only after the first couple of days when I had to awkwardly manouver out of bed and then make my way to the bathroom that I started to stress! (you know the feeling - wondering if your nightgown is pulled all the way down in the back.........???) Anyway - that's what you get here in a public hospital - and apart from that I had no complaints. The nursing staff on the whole were wonderful and I absolutely LOVE my OS! LOL
Next time though..........private all the way!

Peta
 
Peta
You don't generally get much sleep in hospitals, but I would never with 5 other people, then men snoring. I'm glad you survived.
I've stayed at the hospital on 4 different surgeries recently and they must only have private rooms as I always had one. Very nice and I have always appreciated them.
I guess my last room in the more intensive acute area after the seizures had a large flat screen TV. Of course Ihad no idea, but when calling to get the name of the wonderful nurse I had, I found out.

Private next time Peta
Judy
 
Absolutely Judy! I probably should clarify that the only reason I went into a public hospital as a private patient was because my OS wanted to get me in asap and he'd had a cancellation on his private list just 3 weeks after my initial consultation with him. It would have taken longer than that before he could see me privately - busy man!
And even though I had asked for a private room (there are two on each orthopaedic ward) - they were both occupied by patients with dementia/Alzheimers. So not only was there a lot of testosterone and snoring happening - there was also a lot of constant calling out going on day and night. Happy days......! :)
 
Yikes,,,,,Poor you, Peta!!!! If there EVER was an incentive to get out of the hospital,its the sound of those lumberjacks! ,Next time,,,,the first thing you should remember to pack is industrial strength,commercial grade ear plugs to save your sanity!
 
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