Saturday, January 12, 2008

The Cost of Hip Arthroscopy and its Associated Procedures

Amount Billed Vs. Amount Paid by my Insurance Company

Surgery #1
X-Rays $206 $35
MRI $1984 $1614
Intra-articular Injection $1545 $1329
Hip Brace $1100 $684
Surgery $25600 $2268
Anesthesia $2015 $2015
Hospital Bill $15677 $6642


Surgery #2
X-Rays $297 $36
MRI/ Injection (bundled fee since it was done in one day) $3538 $3044
Hip Brace $1100 $684
Surgery $31700 $2831
Anesthesia $2635 $2635
Hospital Bill $18582 $12192


Surgery #3
MRI $1997 $1776
Intra-articular injection $867 $340
CT Scan $467 $467
Psoas Injection $321 $181
Surgery $23100 $1991
Anesthesia $2170 $2170
Hospital Bill $16210 $7849


Many Thanks to United Healthcare for footing the bill, leaving me with no out of pocket fees other than a few co-pays for office visits (not included in this list) and not requiring authorization for any test or procedure. Also, many thanks to J's company for providing this fabulous health insurance!

*Not included in this list are radiologist fees for reading each scan and scans associated with injections and surgeries, office visits, lab fees, cost of the gameready and CPM, plane tickets purchased by my mom, change of fare fees made by mom when extending her stay, co-pays for many, many narcotics, Millennial crutches, lost wages at work, parking garage fees in Manhattan!! (tack on $50/ surgery and a little bit less for office visits!!)

Added on 11/1/10
After successfully fighting and winning my appeal, here is what was billed and paid for in surgery #4

Surgery #4
Billed vs Paid
Hip MRI $2197 $1887
Intra articular injection (cortisone)$1064 $268
Capsule Injection (PRP) $1034 $449
Synvisc One $884 $692
Intra articular injection (Synvisc One) $1064 $298
CT Scan $835 $835
Surgeon's Fee # 4* $19600 $6750
Hospital Fees # 4 $19831 $8533
Anesthesia #4 $2864 $2857
Post-op MRI $2310 $1898


*After appealing to UHC since this procedure was initially denied

A list of ICD-9 and CPT codes used for my surgeries

16 comments:

Jess said...

OUCH!

Anonymous said...

you should have hit your max out of pocket...i know i did anyway with 2 scopes. hopefully that helped you. otherwise....ouch, a lot of $$$$

i am rescheduled for my 3rd scope now, but it hits in the next year...bummer, have to restart!

Anonymous said...

So when you quoted your costs for hospital bill, was that an inpatient procedure? Or was it just a surgery center where you were outpatient for the day? Thanks.

Maria

Susie said...

It was same day surgery in a hospital (HSS). My surgeries were all at 8AM and I went home around 4 or 5PM (longer stay than most for this type of surgery but I don't recover so well from the anesthesia)

Anonymous said...

Did you have any trouble with your insurance company saying the surgery was experimental? I had the scope done Nov 2008 & now Great West/ Cigna is denying the whole thing. We are trying to go through the appeals process, but it is extremely difficult to find out why some insurance companies would pay and others won't. No one explained there might not be enough long-term outcomes to prove its effectiveness.Any advice?

Susie said...

I had no trouble with the billing. Obviously my insurance did not cover the whole thing but that was expected. I had no out of pocket expense. I would wait and see if the surgeons office bills you, they will probably resubmit the claim.

Anonymous said...

They resubmitted their bill along with additional documentation. The denial was upheld. I only have one more appeal. They are saying the surgery is experimental, investigational & that there is not enough long-term outcome studies to prove its viability. Do you know anywhere I can get information on other insurance companies policies about this surgery? Or do you know if Medicare approves of this surgery? From what I've been reading, Medicare sets the standard for other insurance companies like Cigna. By the way, your blog is extremely helpful!

Lola said...

My daughter is 15 and she is scheduled for hip arthroscopy next week from Dr. Byrd (out of state for us. We have United Health Care, but I am aware that the surgery is "investigational" and may not be covered. I feel like I have to weigh medical debt vs my daughters chronic hip pain at such a young age.

Anonymous said...

why so many surgeries. was it not effective the first time?

Unknown said...

Lola,
I am 34 yrs old and a mom of 3. I have had severe hip pain since 12. I found out last week that my femur bone balls are way to large for my hips... I wish my parent's could have done it for me!!! Now I am going to have to go through it with 3 kids and one that is a year old! Hope that helps... Tammy

Anonymous said...

My 16 yr old was just diagnosed with the need for Hip Arthroscpy, Labral repair or resection and Osteoplasty of the femoral neck. So far I cannot find anywhere in network who performs the surgery. The hospital associated with the Ortho. Surgeon is in negotiation with United Health Care, but I cannot find out how close.

Questions: Is there any way you can avoid having this surgery, or is it pretty much a done deal, unless you want a hip replacement in the future?

Also, how many thousands of surgeries have to happen before it it recognized as a normal coded procedure?

Anonymous said...

How come so many scopes? I am going on my third, one for left and second on right because the first doctor only repaired my labrum and never treated my FAI.

Also, I was billed for anesthesia at HSS and insurance covered everything else (minus copay). Did the same happen to you?

Liz H. said...

I'm not sure I understand. . .you had no out of pocket expenses? Who covered the amount not paid for by your insurance company? How much did you actually end up paying for each procedure?

Anonymous said...

Marry Me <3 *snuggles*

Unknown said...

Hip arthroscopy procedure is performed with spinal anesthesia.

hezelshaw said...

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