A $62,068.84 Shoulder

My morning was spent on the phone with insurance companies today. In addition to checking the status of my appeal for my Simponi I needed to get a firm understanding of why Mr. G’s three hour shoulder surgery was $62,068.84.

I love United Healthcare for too many reasons to list, but one of them was the giggliness of the agent. I was thinking that perhaps the $60,000 bill was meant to give me a heart attack and then they’d make a few extra dollars giving me chest compressions before I died? She thought I might be onto something.

At the end of the day the insurance company will pay just shy of $4,000 and we pay $1,000. The good news is that our maximum out of pocket per person is just $2000 so even if Mr G needs a ton of physical therapy (and it looks like he will) our medical bills will end shortly.

I’m unclear on why hospitals do this. Does anyone ever pay $62,000 for an outpatient surgery? Is there anyone in medical billing that make this make sense to me?

The only happy part? They took party pictures, I’ll share of few of them with you after the jump. If you’re easily skeeved out skip them. 

distal clavicle resection surgery

 

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Comments 7

  1. For comparative analysis; my new knee would have ran me 72,000 sans insurance. I’m maxed on my deductible due to the luckiest year of my life. The insurance paid out closer to 10K and my out of pocket was nada.

    Interesting fact? In Canada, my knee surgery is considered elective and not covered.

  2. My favorite part is how the insurance companies send you a bill saying that procedure X cost $1 million but that they only paid $650,000. They don’t tell you that you aren’t responsible for the full amount of the shortfall.

    It always leaves me wondering what the real price should be for these procedures. Because the docs know that the insurance company is going to pay less than the amount they charge so I figure that they mark it up a bit.

    Ya know, pump the price up a third figuring that after negotiations it will land about where they really want it to be.

  3. People without insurance are, in fact, billed for the entire bill and they are liable for it. Many hospitals do negotiate with people who can’t pay. When people can’t pay their hospital bills, the hospital doesn’t take the loss. They just pass it on to insurance companies who pass it on to those of us with health insurance via small raises in our premiums.

    And the bill is that high because we have a profit-driven system (sorry…have to show my liberal colors…my husband is a healthcare policy analyst and we spend LOTS of fun time discussing healthcare cost drivers). The cost of Mr. G’s shoulder surgery is a result of the market demand: the hospital and the insurance company have agreed on the price of that particular surgery.

  4. It’s true. People with no insurance are charged the full boat retail price. Consequently, they lose their homes, their cars, their entire lives. People with insurance are billed the negotiated rate, and insurance picks up the tab minus deductibles, copays, and coinsurance. It’s insane and it’s obscene and it’s the way medicine is practiced in this country. Count your blessings that you’re insured.

  5. It’s true. People with no insurance are charged the full boat retail price. Consequently, they lose their homes, their cars, their entire lives. People with insurance are billed the negotiated rate, and insurance picks up the tab minus deductibles, copays, and coinsurance. It’s insane and it’s obscene and it’s the way medicine is practiced in this country. Count your blessings that you’re insured.

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