Re: Financial costs of surgery

[Guest guest]

Carol...

Most insurance plans cap the amount for which a subscriber is responsible.

I think that mine is $2,000 a year. Check your policy.

I don't think this is the issue you imagined.

___

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....... Original Message .......

On Sun, 15 Oct 2006 23:43:44 -0000 " Carol " <dcvaughan@...> wrote:

>I seem to have brought up a very touchy subject here, but I want to

>see it through. I may be shot by a firing squad by the time I'm done,

>but I want to know what some of you think. The idea that whether a

>person can afford to pay for the revision surgery or pay their share

>of the deductible (insurance)for the surgery. Especially for those

>without insurance--I'm sure that surgery isn't even an option for

>them. Unless somehow they can find a service club or group in their

>community that would raise the money for them to have the surgery.

>Would there even be a hospital or doctor out there anywhere that

>would take payments for a quarter of a million dollar surgery--or

>more-- without a VERY LARGE down payment? It may not be true for me,

>but I think for others out there the financial repucussions would be

>a VERY LARGE PART of whether they could or would have the surgery. I

>suspect that some of the members of these Scoliosis

>sites have probably just faded out and never posted again or just

>lurk because they can't afford to have the surgery in the first

>place. No one seems to want to discuss their financial status or

>whether they can afford surgery. I realize financial and money

>matters are a very personal topic, but where but here, can some

>people get the input they need to make the necessary decisions for

>their surgical options???

>

>My two cents worth.

>

>Carol V. (CA)

>

>

>

[Guest guest]

That's the problem, I don't know what my cap is yet. New policy takes

effect Jan. 1 and we have no info. yet. We know hospital is 100% and

other things are 90%, so if we're responsible for 10% of the costs,

we could be out $25,000. or more out of pocket!! If it really is that

high, we'll have to take a second look at this.

Carol

> >I seem to have brought up a very touchy subject here, but I want

to

> >see it through. I may be shot by a firing squad by the time I'm

done,

> >but I want to know what some of you think. The idea that whether a

> >person can afford to pay for the revision surgery or pay their

share

> >of the deductible (insurance)for the surgery. Especially for those

> >without insurance--I'm sure that surgery isn't even an option for

> >them. Unless somehow they can find a service club or group in

their

> >community that would raise the money for them to have the surgery.

> >Would there even be a hospital or doctor out there anywhere that

> >would take payments for a quarter of a million dollar surgery--or

> >more-- without a VERY LARGE down payment? It may not be true for

me,

> >but I think for others out there the financial repucussions would

be

> >a VERY LARGE PART of whether they could or would have the surgery.

I

> >suspect that some of the members of these Scoliosis

> >sites have probably just faded out and never posted again or just

> >lurk because they can't afford to have the surgery in the first

> >place. No one seems to want to discuss their financial status or

> >whether they can afford surgery. I realize financial and money

> >matters are a very personal topic, but where but here, can some

> >people get the input they need to make the necessary decisions for

> >their surgical options???

> >

> >My two cents worth.

> >

> >Carol V. (CA)

> >

> >

> >

>

[Guest guest]

Carol...

I can’t imagine that Dr. Hu has ever charged anywhere near $250,000 for a few days of surgery. And, unless she is out of network, you should have to pay very little out-of-pocket.

--

On 10/15/06 7:02 PM, " Carol " <dcvaughan@...> wrote:

That's the problem, I don't know what my cap is yet. New policy takes

effect Jan. 1 and we have no info. yet. We know hospital is 100% and

other things are 90%, so if we're responsible for 10% of the costs,

we could be out $25,000. or more out of pocket!! If it really is that

high, we'll have to take a second look at this.

Carol

[Guest guest]

Dear Carol,

The financial part of revision can be very expensive, and yes we have talked to quite a few women through the years who had no insurance to cover surgery that they need, always makes me cry. I'm blessed that insurance covered a great deal of what I went through. My husbands company was going through being bought out during this time period, so two of my surgeries were paid by two different companies, and the third by his new employer. I often wonder if I would have sent up red flags if I was to have all three surgeries with the same insurance. Two of the surgeries were with companies that were self insured, and yes the costs were mentioned to my husband often. His boss even mentioned to me how thankful I should be to the company, and not in a nice way, made us very nervous for his job when layoff's came around. He's no longer with that company. His current employer is self insured, and again the costs were mentioned during a meeting about health insurance and why the premiums were going up yet again. We were never mentioned by name, but when the CEO talked about insurance costs for the company, that there were three major surgeries that year with high costs, everyone knew I was among that group in his smaller company. The company took a huge hit that year, me and a guy in the company who had a motorcycle accident and lost both legs. So even though insurance took care of my surgeries minus deductables and co-pays it's a huge undertaking, and has repercusions. I'm also no longer able to get life insurance through his company, I'm too big of a risk. So this surgery, and in my case surgeries, is hugely expensive and worrysome. ( By self-insured, his company the way I believe it works pays into the insurance which handles all the billing stuff, and after a limit, who knows what, they pay for the rest.)

What Kathy said about not only the costs of the surgeries themselves, big deductables, and big co-pays, can really cramp a families budget, some to the point it's just impossible. How we got through three major surgeries in 24 months I don't know, a lot of sacrifices.I know after one of my surgeries, co-pays for just med's and doctors visits were over 400 dollars in just one month. I look back on it and cry, feel bad for the kids that there sure was less to spread around. We got through it, but the money part was huge, and takes years to get over.

I know for many the costs are just too huge, and so they suffer in pain, and nothing hurts my heart more.

[ ] Financial costs of surgery

I seem to have brought up a very touchy subject here, but I want to see it through. I may be shot by a firing squad by the time I'm done, but I want to know what some of you think. The idea that whether a person can afford to pay for the revision surgery or pay their share of the deductible (insurance)for the surgery. Especially for those without insurance--I'm sure that surgery isn't even an option for them. Unless somehow they can find a service club or group in their community that would raise the money for them to have the surgery. Would there even be a hospital or doctor out there anywhere that would take payments for a quarter of a million dollar surgery--or more-- without a VERY LARGE down payment? It may not be true for me, but I think for others out there the financial repucussions would be a VERY LARGE PART of whether they could or would have the surgery. I suspect that some of the members of these Scoliosis sites have probably just faded out and never posted again or just lurk because they can't afford to have the surgery in the first place. No one seems to want to discuss their financial status or whether they can afford surgery. I realize financial and money matters are a very personal topic, but where but here, can some people get the input they need to make the necessary decisions for their surgical options???My two cents worth.Carol V. (CA)

[Guest guest]

Carol,

I don't think this is a touchy subject at all....you are right...the

reality is that this surgery will have financial impacts and to not

acknowledge that would really be sticking our heads in the sand.

I didn't respond to your earlier question because I thought you were

interested just in hearing from folks who had surgery at UCSF. My

experience was that I used and " in network doctors and hospitals " so

the insurance companies went to them first and billed me the

remaining 20%...but only until MY ANNUAL LIMIT WAS REACHED. This is

the key thing to look at in your new plan, this is the maximum

exposure your family will have during any calender year. So, I first

had to pay my $500.00/annual family deductible, then 20%...until we

paid 4K for the year. Guess what? I never actually went over 4K in

2005(surgery year)...and we had a few other minor medical expenses

that year.

Because my husband was going to be unpaid during the " FMLA/Family

Leave " period to care for me and our child, I thought carefully

about the timing of the surgery. I wanted it to be early in the

calender year...so as to accumulate as many medical expenses in the

same calender year....that way if my surgery got all the way to the

catestrophic limits, any other expenses would be covered 100%.

The other technique we employed was to use my husbands " health care

spending account " . If you have acccess to this program (U.S. only)it

may be very helpful in " flattening out " surgeries expenses. Here is

how they work:

Prior to the beginning of the plan year (so this would be November

for most of us) You make an estimation of how much your " qualified

medical expenses " (this is an IRS driven program) will be. There is

usually a " cap " on how much you can elect....the caveat is to be

careful of is that whatever amount you choose, YOU MUST SPEND IT

ALL..it will not be reimbursed if you overestimate.

For us, I knew that my catestrophic limit was 4K...I knew we usually

spent around 1K in unreimbursed medical expenses...and I knew that

we had some case reserves to meet some of the smaller bills that

were going to come in for the surgery. So, the year of my surgery we

elected $2,500.00 for our health care spending account. What this

meant was every month the approx. $200.00 was taken from my hubbys

paycheck, but I could file for up to $2,500 as early as January 1st.

Make sense? Basicaly the company is " fronting " you the money that

they know you will pay back over the course of the year. In my case

I knew my bills would start coming in big chunks right while our

income was at the lowest...so this helped a lot. There are also tax

benefits of using this type of account as the $$ is also withheld

tax free.

The health care system in this county is disjointed and unfair. I

don't know about CA, but MA is one of the first states to cover all

its residents....through a variety of initiatives...and hopefully

the rest of the states will eventually follow suit. Until then, all

any of us can do is pay attention to what our state and federal

govt. is doing about seeing that no one goes wanting for health

care. Of course, anyone who wants to move to MA is more than

welcome...nice seasons....excellent medical care....a bunch

of " revisees " to hang with!

I hope I haven't confused you too much.

Take Care, Cam

[Guest guest]

as I see it, insurance companies really don't like to pay. When I

was young, I went many years without insurance because I saw it as a

form of gambling -- it is like you are betting that something bad

will happen to you.

now that I am older, I definitely need insurance! I first got

insurance when I first started teaching in 1994. The insurance I

had for several years was an HMO and I had to get approval to see a

specialist, and then I could only see one that contracted with the

clinic where my PCP worked. The orthopedic doctor was terrible, so

that is why I didn't see one until my husband got a job with decent

PPO insurance. I really miss his Blue Cross and even Aetna PPO,

because it seemed like I didn't have to pay any out of pocket with

them -- and their network was nation-wide.

Now I have insurance through my job again -- a PPO, but it is only

statewide. They supposedly pay 80% for network providers and I

supposedly have a maximum out-of-pocket of $3800 for the year.

However, I noticed that the statements of benefits they send always

have a large " member owes " amount for my pain management treatment.

Even though the hospital where my doctor does the procedure is not

in-network, I assumed that once I got to my maximum out of pocket,

that the insurance would take over (and just one treatment meets the

out of pocket)

I got a letter from Dr Bridwell's office that my insurance has not

paid, and that if they don't hear from them within 15 days, I will

be responsible. I had talked to my nurse case manager about the x-

rays and PT charges that were not covered at all, and she suggested

that I call customer service.

So, I got out all my statement of benefits forms from my insurance

company this morning and made a spreadsheet. I see that they have

paid $19524.24 in claims this year (at least of the papers I had

tossed in my 'medical bills' basket). The total amount in

the " member owes " columns turned out to be $13142.34 !! Breaking

that down further, $150 was co-payments ($25 for each doctor visit),

$3850 for 'co-insurance', $300 for my deductible, and $7861.95

for 'amount not covered' (mostly for pain management).

So, now I am ready to call my insurance company and find out if they

will pay for the xrays and evaluation by the physical therapist that

Dr Bridwell ordered and why the heck haven't they paid Dr Bridwell

since I had 'administrative approval' to see Dr Bridwell.

Meanwhile, my husband changed jobs partly because I was hoping to

get better insurance again. It seems that even hospitals have gone

to cheaper insurance plans. I was hoping that since I have coverage

with two companies, that I would have less to pay out of pocket.

But, no, my husband's insurance company says that the maximum amount

covered by either company is the maximum that can be paid by the

companies together. ARRRGGG!! I am going to have to figure out if

I am better off having my insurance company pay for Dr Bridwell

since they approved him, or if it would be better to file with my

husband's insurance since Dr Bridwell is in his 'extended network'

I am just glad that it doesn't cost any more for the premiums for me

to be on my husband's insurance than it would for just the kids. My

job pays the cost of my health insurance -- I just pay for dental

and vision insurance. (thanks to the state legislature who decided

they should pay for our insurance instead of giving us a raise)

you know what is weird?? we just got our brochures to pick

insurance for next year, and the HMO premiums are much higher than

the PPO -- no wonder that is the one that the state pays for in full.

I am glad that my pain management doctor asked the hospital to bill

me only for the amount that my insurance would pay if they were in-

network (he can do that since the doctors who work there own the

hospital). Unfortunately, they still want the 'co-insurance'

So far, I have just been tossing their bills in my basket for the

last two years. Maybe it is time to call and offer to pay them $25

per month. It has been my previous experience that hospitals will

usually agree to take a small monthly payment and as long as you

make them, there is no problem. Sometimes, they eventually quit

sending the bills long before they are paid off.

[Guest guest]

The doctor may not charge that much, but I wouldn't be surprised if

the total bill for the hospital, etc came to that amount.

>

> Carol...

>

> I can¹t imagine that Dr. Hu has ever charged anywhere near $250,000

for a

> few days of surgery. And, unless she is out of network, you should

have to

> pay very little out-of-pocket.

>

> --

[Guest guest]

Carol,

Even plans that pay only a percentage of a fee have an out-of-pocket-maximum, which is usually 2000-3500 per person per year. In other words, if the plan pays 80% and you pay 20%, it usually means you pay 20% until you've paid a total of say $3500 per year and then the plan pays 100% of the remaining costs for that year.

Bonnie

Re: [ ] Re: Financial costs of surgery

Carol...I can’t imagine that Dr. Hu has ever charged anywhere near $250,000 for a few days of surgery. And, unless she is out of network, you should have to pay very little out-of-pocket. --On 10/15/06 7:02 PM, "Carol" <dcvaughansbcglobal (DOT) net> wrote:

That's the problem, I don't know what my cap is yet. New policy takes effect Jan. 1 and we have no info. yet. We know hospital is 100% and other things are 90%, so if we're responsible for 10% of the costs, we could be out $25,000. or more out of pocket!! If it really is that high, we'll have to take a second look at this. Carol

[Guest guest]

I am trying to figure this out too. I called my insurance company

peior and asked a ton of questions including making sure my doctor and

anathesiologist were both in-network. Also asked what questions

should I ask that I haven't and his response was that I am asking more

than most people do! I am fortunate to have high healthcare coverage

with 100% on some items, 90% on others and a $1,000 max cap after

annual deductible.

I can see the claims that have already been submitted as they are

posted to my healthcare website (my login required). How things have

changed since we tried to manually track the claims 24 years ago with

the first surgery! Dr. Lauerman billed $62,600 and the claim is

pending. What we don't know is how that compares to the reasonable

and customary charge for this procedure. Several other doctors and

lab charges are posted. Anatheseia doctor was $12,000. I don't see

the hospital charge yet. So far my co payments equal a few hundred,

but it is still very early yet. Meds for use at home were charged

under routine insurance meds coverage. Cost for my advance blood

donation and a physical with my primary care are also pending.

There were also miscellaneous costs associatied with accomodation

items for home (e.g. toilet seat riser, grabber, pjs, satin sheets,

jog suit and slip on shoes). My sister leant me an aerobic step for a

sturdy step to help get in bed. And the hospital sent home the " 3 in

1 " commode (didn't take) and a grabber and sock aid. My family

incurred parking charges which were reduced after day 4 I think. I

didn't have any need for cash in the hospital.

I'll try to remember to update with more info on this subject in a few

weeks as we see the claims process along.

Best,

Annette in Arlington

2 weeks post surgery!

[Guest guest]

Yes, Suzann, that's what I thought, too. The total cost might be around

that amount. Doctors probably don't charge that. (unless there's some

kind of terrible complication or something)

Carol

> >

> > Carol...

> >

> > I can¹t imagine that Dr. Hu has ever charged anywhere near $250,000

> for a

> > few days of surgery. And, unless she is out of network, you should

> have to

> > pay very little out-of-pocket.

> >

> > --

>

[Guest guest]

Re: Financial costs of surgery

Posted by: " SB " bahadreama@... bahadreama

Mon Oct 16, 2006 7:08 am (PST)

" because I saw it as a form of gambling "

This is sort of off subject, but I'll make it short.

My ex-husband just told me that now he has to pay for

insurance he feels it was too expensive to pay 100.00

per month since he is healthy & never gets sick and

workmans comp will cover any injuries at work. WELL,

not a half hour after he told me that, while he was

replacing the flooring in our old (100 years plus)

house the pneumatic nail gun recoiled as he tried to

nail a 2 X 4 to a hand hewed oak log and had a 3 inch

barbed nail go through the back of the wrist to the

palm of his hand. Well, he decided to keep the

insurance after all.

Those of us who have needed insurance for most or

all of our lives don't think of insurance like healthy

people do.

Lynne Gaither

Hanover, PA

Fused T5 to L4 in 1983 at age 26 years w/harrington rod.

__________________________________________________

[Guest guest]

i hope your husband is ok -- that sounds very painful!

back when I was young and healthy, I had insurance for one year --

the year that my son was born. I figured up the cost of the

insurance premiums vs. the costs I would have paid the doctors and

the hospital and they worked out just about even.

I think my husband has only seen a doctor once in the ten years we

have been married -- and that is when the rest of the family had

been diagnosed with mono. But even though he doesn't use his

insurance, the rest of us sure do!

>

> Re: Financial costs of surgery

> Posted by: " SB " bahadreama@... bahadreama

> Mon Oct 16, 2006 7:08 am (PST)

>

> " because I saw it as a form of gambling "

>

> This is sort of off subject, but I'll make it short.

>

> My ex-husband just told me that now he has to pay for

> insurance he feels it was too expensive to pay 100.00

> per month since he is healthy & never gets sick and

> workmans comp will cover any injuries at work. WELL,

> not a half hour after he told me that, while he was

> replacing the flooring in our old (100 years plus)

> house the pneumatic nail gun recoiled as he tried to

> nail a 2 X 4 to a hand hewed oak log and had a 3 inch

> barbed nail go through the back of the wrist to the

> palm of his hand. Well, he decided to keep the

> insurance after all.

> Those of us who have needed insurance for most or

> all of our lives don't think of insurance like healthy

> people do.

> Lynne Gaither

> Hanover, PA

> Fused T5 to L4 in 1983 at age 26 years w/harrington rod.

>

> __________________________________________________

>

[Guest guest]

Lynne,

Yeah, no matter how many times I try to tell my son that the

definition of an " accident " is that is an unplanned event....

Cam