$80,000 for a hiatal hernia repair?!? And I am self- pay!

Janet M.
on 3/15/13 4:21 am - WA
VSG on 12/27/12

This was exactly the info I was looking for, thank you!  How yours was handled seems to me the most reasonable and I sure want someone at my surgery center to explain the HUGE discrepancy.  No wonder our medical system is so messed up. cool

    

        
melanieannd
on 3/15/13 4:28 am - TX
VSG on 06/13/12

You are welcome. :) Let us know what happens!

   
    

Check out my blog, http://www.missingmelanie.com and like me on Facebook. :) http://www.facebook.com/pages/Missing-Melanie/618740441485479

Deckeriv
on 3/15/13 4:20 am - TX
VSG on 03/26/13

I'm not going to say it's a mistake and it is probaly a business office trying to rape an insurance company, which is normal for our health system. That is most of what is wrong with our health care system.

I had my EGD this morning and found out I have a small hernia that he will repair in 10 days when I have my sleeve surgery. I am self pay for the sleeve but all my pre-op stuff was picked up by my insurance. My hospital charge for two nights and the anethesiologist was going to be $7,100 but since they are going to be charging the insurance for part of the surgery now, my out of pocket cash cost is dropping to $4,000 for the hospital. The surgeon was $6,000 cash and that isn't changing.

I have no idea what they will charge the insurance company but they will get what they get and I'm not paying anything else like co-pays or deductibles.

You will get your issue resolved and they will back down. I bet your COE is not expecting your $24,023 and will be happy with how much they got from insurance. Wrong, I know. Eye of the tiger....


  

    800 calories and less than 20 net carbs is the shizzle

 

    

Janet M.
on 3/15/13 4:43 am - WA
VSG on 12/27/12

What your surgery center/hospital is doing in essentially the same cir****tance makes total sense to me.  For those of us who have insurance but it does not cover bariatric surgery and we DO have additional procedures that ARE covered by our insurance it would seem to me that instead of basically double dipping they would have reduced my part of the cost that my insurance also paid for.  And you are not telling me the at $44K+ they weren't paid eugh already!

    

        
Dev *.
on 3/15/13 5:08 am - Austin, TX

Have you talked to the doctor's office? are they actually asking you for that money, or are you just looking at your explanation of benefits from your insurance company?

An EOB is not a bill and what it says may have no bearing on what your doctor's office actually says you owe, if anything.

When medical charges are submitted to an insurance company, they are always for MUCH more than the insurance company actually pays - the insurance company typically has a contractual rate with the provider - and they are far more than you would be billed for if you were paying out of pocket. So, even if your surgeon billed your insurance for $80,000, they were never even expecting to get that from your insurance company, they are just expecting whatever their agreed upon reibursement rate is.

Banded 03/22/06  276/261/184 (highest/surgery/lowest)

Sleeved 07/11/2013  228/165 (surgery/current) (111lbs lost)

Mom to two of the cutest boys on earth.

Janet M.
on 3/15/13 5:30 am - WA
VSG on 12/27/12

Yep, I know all of this and yet it it still a completely wrong situation.  I have been trying to reach someone in their billing department all week and no response.   This is on top f the fact that my surgeon was suddenly on medical leave and instead of one of his partners stepping in to cover his follow up appointments and deal with problems we are being seen by their ARNP. Now, don't get me wrong, on most days I would prefer to see an ARNP they are the best in my book, but she is also mostly unavailable and hasn't returned my call about what for me is a serious problem since I left her a message last Friday.  So, all in all, I am left with the feeling that this particle surgery center has been grossly overpaid and are still leaving me hanging out t dry.

    

        
Deckeriv
on 3/15/13 5:11 am - TX
VSG on 03/26/13

I bet you never get a bill for the $23K. The EOB is saying that insurance is not paying any more but I bet the surgeon is fine with his $44K and won't want your co-pay. Not saying the office might not try to get it but I bet you can work it out without paying anything and not having an "unpaid" bill.

The health care billing system is so screwed up, even the people in the middle of it don't understand it.


  

    800 calories and less than 20 net carbs is the shizzle

 

    

a_gritters
on 3/15/13 7:26 am
VSG on 03/19/13

I highly doubt insurance paid them $60K, there is ALWAYS an adjustment that hospitals have to write off.  I work for a hospital most insurance companies only pay a percent of charges, for instance Medicare only pays us 56% of charges.  There are also alot of costs that hospitals spend and can't charge for.  It seems like hospitals charge alot, but there is reason... insurance companies will never pay 100% and like to reduce their payments each year. 

NOW as for the $80K+ in charges...thats just insane, even with a mark up that is far too much!  I also would never pay the $24K if they bill it as they should have made you aware of this before before having services done.

HW 315; Surgery Date 3/19/13, SW 300.5;  PreOp: 14.9, W1-4: 21.2, W5-8: 15, W9-12: 13.4, W13-16:

  

 

        

Janet M.
on 3/15/13 8:03 am - WA
VSG on 12/27/12

Actually, between what I paid n cash and what the insurance paid they were paid just over $60,000.  I was billd just under $17,000 and my insurance was billed $80,000.  I also did not have my surgery at a hospital but at a same day surgery center in the same office building as my doctors office.  I was there for a few hours and then released to go home.  No room, just a nook, no extra nursing necessary, and the $80,000 they billed my insurance for was for a procedure that appears to take just a few more minutes of their time.  So I definitely get the hidden costs that are there when you are hospitalized but that just wasn't my situation,at all.

 

    

        
a_gritters
on 3/15/13 11:10 am
VSG on 03/19/13

Wow!  I will just say that's insane... wish insurance companies paid our hospital that well.  Part of it could be because it was a surgical center.  But I agree in that they definitely over charge holy moly!

HW 315; Surgery Date 3/19/13, SW 300.5;  PreOp: 14.9, W1-4: 21.2, W5-8: 15, W9-12: 13.4, W13-16:

  

 

        

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