What does insurance actually pay? - ThinnerTimes

StacyBee160 · 04-24-2007, 12:21 PM

I've been working with a patient lately who has also been looking into surgery, and has visited a couple of times with a doctor in the area who has the lowest self-pay price I think in the whole state. He charges $11,500 for LAP-RNY, and $5,000 of that is his fee. He told this patient that when the insurance pays, he usually gets much less than that, more like $1,500 - $2,000.

Does that sound right at ALL? Does anyone know offhand what your insurance actually paid out of what was billed?

Thanks in advance!

ceekerr · 04-24-2007, 02:08 PM

OK, here goes:

Hospital ...........33,506.45
Surgeon 1 ........ 5,550.00
Surgeon 2 ........ 2,000.00
Anethesologist... 1,105.00
Anethesologist... 260.00 (pending payment for some reason)
TOTAL $42,421.45

This is what has been paid by BC/BS of Ala (Peehip) for my surgery.

Carol

Haveaball · 04-24-2007, 03:50 PM

Harvard Pilgram paid the hospital, doctors, and room etc a fee of over $35,000.

Casinocat74 · 04-24-2007, 04:45 PM

My surgery totalled $57,800.00. That includes EVERYTHING. The LAP band removal and the Bypass. I have United Healthcare and they paid $55,800.00.
So I only had to pay $2,000.00
I guess it depends on the Insurance and the Doctor.

Gina in NY · 04-24-2007, 07:59 PM

I forget exactly how much my surgery was - there were so many little charges. Anyway - it was about $24,000 all together, and I know the surgeon got about $3,000.00 of that. Doesn't seem like much, but he was only operating for an hour and 45 minutes. Not a bad pay scale really.

StacyBee160 · 04-25-2007, 06:37 AM

I just wondered... I knew the Dr. had to be making more than $1400 off the insurance, but if there was any indication that the hospitals charge self-pay patients more than they get from the insurance companies, I'd have thought about using that to negotiate if necessary.

Thanks for the responses so far!

LisaM · 04-25-2007, 06:56 AM

I'm on Tricare Prime, the military retiree's insurance, and they negotiate pay rates for all healthcare that varies from 25 cents to 75 cents on the dollar, according to the procedure. I would agree that it's a real negotiation point for a patient interested in self-paying.

Mavis · 04-25-2007, 01:48 PM

My insurance was through the State of New Mexico.
While the charges were pretty steep the actual benefits approved were much lower.
The hospital charged 70,063.25 Benefits paid 9676.12 (co-pay 300.00)
Surgeon #1 6,180.00 1984.34 (co-pay 30.00)
Surgeon #2 6,180.00 337.34
Anesthesiologist 2,806.00 1101.21

So out of total charges of 85,229.25 the insurance company paid benefits at 13,099.01 and my co-pay was 330.00. And from my first appointment to my surgery was a mere 5 weeks. I really lucked out.

Good luck with bargaining with the hospital..it has been done. Just make sure you get it in writing with a paid in full stamp, so there are no "miscellaneous" charges.
Mavis

jamie · 02-10-2008, 11:48 AM

Quote:

Originally Posted by StacyBee160

I've been working with a patient lately who has also been looking into surgery, and has visited a couple of times with a doctor in the area who has the lowest self-pay price I think in the whole state. He charges $11,500 for LAP-RNY, and $5,000 of that is his fee. He told this patient that when the insurance pays, he usually gets much less than that, more like $1,500 - $2,000.

Does that sound right at ALL? Does anyone know offhand what your insurance actually paid out of what was billed?

Thanks in advance!

can u please give me more info. about that DR. ?

jamie · 02-10-2008, 11:55 AM

Can you please give me the doctors phone no.? and the location? Thanks in advance!