consumer perspective – cost of inguinal hernia repair surgery – First steps.

December 18, 2012 in health care costs, Member Stories

I’ll be undergoing this procedure  later this week and reviewing costs is part of the process.

I understand that hernia surgery is routine. I called the hospital, surgeons office and insurance company. As I just summarized for a friend:

Hospital says $18,385. Surgeons office says $1450. Insurance company says don’t worry, the most you will pay is $5k.  Why is it that I feel like the mafia is running healthcare? There is truth in all those numbers. What is the truth exactly?

I expect I will get a bill like I got for my colonoscopy. Horrifying billed cost, miraculous adjustment from insurance company but still a high bottomline relative to the rest of  the country.

 

 

4 responses to consumer perspective – cost of inguinal hernia repair surgery – First steps.

  1. Hi Michael – first, I’m sorry you need to have this done. I hope the procedure goes very smoothly. $5k is still a lot. Is this your deductible? Oh, maybe you have co-insurance?

    You’re right, there’s very little truth or straight talk in health care pricing. It’s crazy.

    And what happened with your colonoscopy? I’m shopping for one of those right now.

    Keep us posted!

  2. FIrst, regarding the colonscopy.
    I have had two. The first about 6 years was billed in the way I describe. The one recently was completely covered by my insurance. When I called the insurance company, that was all that they would tell me, i.e. the procedure was completely covered by my insurance; there was no cost to me; the person I was speaking to did not have access to the actual cost of the procedure. Both colonoscopies were performed by the same group of doctors. I was actually reluctant to return to them given my first experience, which I had mentioned to my personal physician. He acknowledged that that colonoscopy clinic did exhibit some billing anomalies but said that they had been resolved.

    Regarding the hernia repair: The bottom line cost $1411.53. $777.03 to the surgeon’s office. $634.50 to the anesthetist’s office. I had the procedure done at Newton Wellesley hospital. I was very satisfied with every thing about the experience.

    I neglected to mention in my original post that when searched on-line, I saw a spread of prices from $2300 (no-insurance hernia repair clinics) to $30k in Bishop CA. San Francisco had the highest average rate at $12K and Boston in general was high also at about $10k. Web sites appeared to be recommending clinics in Arkansas and South Dakota as the best places for this sort of surgery. No web site I saw gave me any confidence that their information was accurate, current, well researched.

    So I have mixed feelings about this. On the one hand, it feels like costs are headed in the right direction. On the other hand, I was unable to get accurate information for making a rational decision before the procedure. I could have put off the procedure until I was confident. I was assured that this was a frequently performed routine operation. Nevertheless, prices varied an order of magnitude.


  3. Billing Update:

    _____________________________Charged_______BCBS____Adjustment______I Paid
    __________________________________________payment
    1. Surgeon
    ______Comprehensive visit_____410.00_____222.51_______-162.49________25.00(copay)
    ______Surgery________________1450.00_______0.00_______-672.97_________0.00
    2. Anesthetist_______________1125.00_______0.00_______-490.50_______634.50
    3. Hospital_________________17180.23_______0.00_____-15992.54______1187.69

    Totals______________________20165.23_____222.51_____-17318.50______1831.19

    I requested and got an itemized bill of the hospital expenses which were:
    1 Operating room charge_______10,882.06
    2. mesh material cost__________3,640.00
    3. Anesth. technical charge____1,371.08
    4. Recovery room charge__________902.00
    5. OR room team__________________278.77
    6. misc drugs_____________________98.32

    To me the interesting items are:
    ____1. The doctor expense totalled about $3000 reduced somewhat by "adjustments"
    ____2. The hospital expense was massively reduced by "adjustments".
    _______Bill itemization did not reveal the distribution of adjustment.

    It appears that most of what I paid went to the doctors.
    The majority of the transaction, I can only describe as an accounting agreement
    between the the hospital and insurer. I have no idea what that means in the larger picture

  4. My hernia repair was completely normal and cost $29K.!!

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