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gloucesterman

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I just saw the bill for my TKA of my left knee and the total billed to my insurance company for my three day stay at the hospital and the surgery was $77,326.00.... I understand this is just for the surgery and stay and am just curious what the costs are as billed to the insurer...
Gloucesterman
 
It all gets billed to them. Question is what they will pay for. My 2 knees at the same time was $86,000+/- . Surgery on Tuesday, home on Sat. (4days?). But then add tests, Anesthia, radiology, pathology, surgeon. At least $100k for me I think. thank goodness for insurance. Otherwise I'd still be sitting w/bad knees.
 
It all gets billed to them. Question is what they will pay for. My 2 knees at the same time was $86,000+/- . Surgery on Tuesday, home on Sat. (4days?). But then add tests, Anesthia, radiology, pathology, surgeon. At least $100k for me I think. thank goodness for insurance. Otherwise I'd still be sitting w/bad knees.

Hey Jennifer, Oh I know about the contracted pricing that is why I mentioned the charged price and numbers of days in the hospital only. It gets completely personal after that considering all patients recover differently according to a myriad of factors.. Thanks for your input I am just curious to see if the pricing is all over the board as costs of health care can be.
Gloucesterman
 
I'd imagine the ratio/percentage/formula (LOOKING FOR THE TERM) would be the same whether you were evaluating the difference in an itemized column or the entire package. I'm wondering if it is like the mechanic. they have a book with a rate per repair. If they finish a 1 hour job in 30 mins same price as if they took 2 hours. Back to humans like you said, ofcourse if I needed an ultrasound that you didn't that is an additional charge. I have a friend who works in the billing dept of an OS. i'm going to ask her.
 
Glouc,

Each of my knees were about $50K, retail here in the DC area. Payment from insurance was about $19K. I was in Monday morning and out Wednesday afternoon each time. I still have a couple of joints to replace. I'll have to ask my surgeon for a discount on the next one. He said I was like family?!?!? Actually, I didn't have to pay anything so I'm okay with the cost...
 
I had to pay $250 co pay for the hospital admission but that was all.
 
WOW!!! Thank goodness for free healthcare in Ontario (O.H.I.P.). I am paying for my physio at the moment as I only get $1,000 per year, but that's only $40 per hour. (I am usually there for almost 2 hours but they only charge for one!!
 
Good grief....West Michigan is CHEAP compared to the rest of you. I have good insurance, so maybe I did not see the bills properly but I think my new knee, hospital, doctors and all was around $17,000.
 
Vermont also seems to be less expensive. I had BTKR and was on the surgical floor for 3 days and the bill was 57,842 (Surgery went 3 hours longer than most) and anesthesia, x-rays, asst. surgeon came to about 6400. The bill for the 11 days of inpatient rehab was 22,163. The surgeon's fee was 6500 plus 1148 for the computer aided systems. The insurance (after first saying they would only pay for 7 days of rehab) paid for the majority of it expect for the $1148 for the computer as they said that was not covered under my policy. The OS wrote that off so for the hospital end I just had the $800 deductible. They pay 70% of PT and so far my out of pocket for that is 945. Overall the out of pocket has been around $2200 so far (I am still in PT).

Yes location has alot to do with things.
 
Hey Gretchen,

I'm in Kalamazoo, and my hospital bill alone was almost 50,000. BC/BS paid 33 thousand and change. My part of that was $100.00. I think Medicare pays even less. I'm sure the original charges in GR would be pretty comparable.
 
Glouc,

Each of my knees were about $50K, retail here in the DC area. Payment from insurance was about $19K. I was in Monday morning and out Wednesday afternoon each time. I still have a couple of joints to replace. I'll have to ask my surgeon for a discount on the next one. He said I was like family?!?!? Actually, I didn't have to pay anything so I'm okay with the cost...

Karen, are you saying that you are in the hole for $31k per knee after insurance? OUCH!
 
Oh no. I didn't pay anything!!!! reread last line of quote above. Not one cent for either knee, not even for physical therapy! I have BC/BS and Tricare Standard.
 
OK now that we have established that I am tired, hurried and maybe don't know how to read....... ; )
 
My surgery bill for the operation and a 5 day stay was about $42,000. However, the amount they accepted from insurance for full payment was about $6,700. I paid nothing.

I did think, however, that if I hadn't had insurance I might have been responsible for the entire amount, which seemed nuts to me.

I think the insurance payments are based on what is "usual and reasonable" for a particular geographical region. Which makes me think that the posted cost is pretty unusual and unreasonable!
 
We're in California. I haven't gotten a bill for my knee yet but my husband's LTKR, with a 3 night hospital stay, came to $76,000... and that was without the OS's and anesthesiologist's bills. Luckily we're both on medicare, so with our supplemental insurance, we don't pay a dime out-of-pocket. Sometimes, being over 65 years of age, has it's advantages!
 
My hospital bill in San Diego was $62,000. My insurance (with adjustments) paid everything but $1,000. They have paid a lot to the docs and PT, too. I am pretty satisfied.
Dee Ann
 
So far my insurance has paid $117,000.00 and change for two knees, hospital stay from Tuesday to Sunday. Thank God we have good insurance and live in an age when such surgery is not only possible but becoming more and more common. It certainly restored my life and I am forever thankful for that. Rowdy
 
The Dept of Veterans' Affairs paid for mine. However, I'm still trying to get physical therapy to improve my gait and for strength training so I can get back on the ambulance. I had about 6 home visits but no real physical therapy at all. Once I went to work, the PT stopped.
 
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