is $28,000 excessive for a bunionectomy...performed at the HSS by Dr. John G. Kennedy as an outpatient not including a $9,000. charge for hospital services and $1,400. for anesthesia? My insurance would pay only $6,500.00 of the $28,000.00 bill

I personally think it's high. I paid under $6,000 for a double bunionectomy with spur removal, including the surgeon, outpatient surgical center and anesthesiologist. I received several discounts for uninsured and prepay and having the 2nd one done at the same time, and I got the prices before the surgery. I think its high because that's what they bill to insurance companies and don't expect to be paid that much.

The hospital services and anesthesia sound comparable to what I had, but the $28,000 seems very high. You may be able to negotiate a lower price by presenting the evidence that your insurance won't pay the majority of it. What reason did the insurance give for covering about 1/4 of it? You might be able to use that reason in negotiations.
Sorry to hear of your bad luck!

Close to $40,000 for one foot? Sounds high to me. (Mine was about half of that for two feet and HMO insurance paid 100%.) Where are you located?

I take it the surgical center/hospital was not participating with your insurance company. I went to a surgical center that was nonparticipating for a bunionectomy 18 months ago but they accepted what my insurance paid. Likewise with the anestheologist. My doctor was participating and the funny thing was the insurance paid the anestheologist more than they paid the surgeon (now I understand why some don't participate). However all told mine was probably closer to $12,000 (billed but not actually paid). Anestheologist got around $1200 and my surgeon got a little over $1,000. Good luck dealing with all this. It's a terrible position to be in.

Mary in NY

sorry to repat but that seems so high priced. hope you can get it straightened out. also i hope the surgery went well.

Between the doctor, hospital, anesthegologist, etc. my insurance company was billed around $28,000 - of course, they didn't pay that much. If you have insurance, there is a huge difference in the amount billed and the actual acceptable amount the insurance company will pay. My part ended up being around $500.00. This was for a bunionectomy on one foot.

Suggestion since I have been exactly where you have been but with a different surgery, same doctor. I have insurance but Dr Kennedy was out of network and the hospital is in network. This is how I handled it and hope the suggestions work for you. First, I appealed to my carrier stating that Dr Kennedy was the only surgeon in my area that could perform the surgery as there were no surgeons in the network that could perform the surgery. This might be a tad difficult since your surgery is a bit more common but you can try. My carrier calls this a provider exception. I did get a provider exception so that helped in a round about way.

Also, if there is a difference between the amount you have to pay and the amount insurance decides is 'customary and reasonable', then you have two options and I did them at the same time. I asked PMI, Dr Kennedy's financial company (they send you the bills) to discuss with Kennedy of he will accept the insurance carrier's check as payment in full. Most surgeons do this. I would put that request in writing. In the meantime, write to your carrier and indicate you are appealing their decision to only pay XYZ amount. Tell them your surgeon thus far has not accepted that as payment in full. Ask them to 'reprocess the claim' and request specifically for the difference. The interesting thing is when I did these two options simulatneously, I got an answer (a positive one at that) from the carrier before I received an answer from PMI.

If you have any questions, let me know.