My husband is in the process of a settlement negotiation with the insurance company handling his worker's comp case. He has a lawyer. The lawyer drew up a proposal and put in $20,000 for the surgery. He has a herniated disk in his neck. He wants to know if that is a reasonable amount if he has no medical insurance and decides to have surgery in the future. Right now he doesn't want to have the surgery. Does anyone have any idea how much these surgeries cost? Thanks
That is extremely low. If he ends up needing a fusion it can cost up to 100k for the hospital bill. This does not include antheisologists, surgeon fees, etc.
Not to mention that if you have fusion you may have future level problems requiring meds and surgery. You also should be aware that this may be deemed as a pre-existing condition and he may have problems getting future insurance.
Frankly my non-medical advice is to think long and hard about settling. With spinal injuries you never what the future holds.
It depends on the area you live in, the doctor you use, the hospital, and, of course, exactly what he would have to have done. Costs vary quite a bit. But I can tell you that my fusion surgery last year came to $265,000. That doesn't include copays for office visits or for the outpatient testing, like the CT scan and bone scan.
Don't let them pressure you into settling until you're sure you have a fair deal that will really take care of him.
Most WC attorneys will get 20% of your monetary settlement, so they are going to try to get you to settle for the most money in lost wages and little money in medical (they get nothing for medical portion). The insurance company will be really happy to settle for very little medical and more for wages because they know medical could run as high as half a million for surgery with complications. No other insurance company is going to pay for any treatment on your husbands neck because it is a work comp case. Work comp will not have to pay on it because he signed off on it.
What it is going to boil down to is how badly you want the lost wage money vs how much you want to risk having very little problems with the neck in the future.
If you ask to keep the medical open or for a realistic figure for future medical, the insurance company is going to offer substantially less money for lost wages. The insurance company has a dollar figure that they believe the future medical will cost, lets say 250,000. So they would come out way ahead if they offer 80,000 for lost wages and 20,000 medical. But when you say you want to leave the medical open, they will say oh, then you will only get 20,000 in lost wages.
The first way your attorney gets 16,000 but the other he will get 4,000. Your attorney is going to push for the low medical for that reason alone. Don't ever assume he is looking out for your best interest, he is trying to get you some money but only the money that is going to get him the biggest paycheck. Make him work for his paycheck, make him negotiate. Find out how high they are willing to go for lost wages, then tell the insurance company you want open medical for life and have the attorney negotiate the low-ball figure up toward what they were offering with the lower medical.
I had 2 level fusion (9 hours) and some other work done. Bill for only one Dr - my surgeon was $135,000. His assistant charged my insurance for $50,000 and another Dr who during the surgery wathes spinal cord charged $65,000.
I don't talk about anesthesiologist and hospital stay...
Of course prices depend on what was done,etc. but gosh, so expensive.
I would do surgery now and than settlement. In my opinion $20,000 is not money to cover all expenses you will face.
Good luck to you and your husband!
Thank you all for responding. Actually, none of the settlement proposal mentions lost wages. It's all based on the rating from the doctors regarding the injury. He's been getting weekly money for being out of work.
I have to agree with Chris, why not have the surgery first? What if there is some after affect from the surgery that will need more medical costs?
I had my 2 lvl fusion Nov 06, between the surgery and the hospital it was $300,000.00 and that does not include any of the pre surgery tests and any other procedures I had before the surgery. And I have problems after the surgery that needed to have more test done.
I am so glad I have not yet done any sort of settlement with my workers comp yet, my lawyer kept telling me to wait on that over the past 6 years and I am glad I have listened, because you never know what can happen afterward. I remember back in 2002 (I was injured in 2001) the insurance company wanted to settle with $35,000..yeah that sounds like a lot of money, but apparently it is not near enough.
Let me ask another question, then. If you don't settle, they stop paying, at least that what we've been told. How can you survive without income or, what kind of job can you get if you have this disk problem? We cannot afford to do with one income. They've already stopped paying him for the back injury a long time ago. He had a knee injury at the same time which he did have the surgery for and just got a rating on that. The settlement would be for both.
Let me ask another question, then. If you don't settle, they stop paying, at least that what we've been told. How can you survive without income or, what kind of job can you get if you have this disk problem? We cannot afford to do with one income. They've already stopped paying him for the back injury a long time ago. He had a knee injury at the same time which he did have the surgery for and just got a rating on that. The settlement would be for both.
My case is still active, I still get my stupid "little" workers comp check each week. It may also depend on the laws in your state. My case is a North Carolina case, I was injured in NC, but now live in Wisconsin. The reason I was able to go from 2001 to 2006 for my surgery is in NC, all you have to do is request your medical stay active every 2 years, I did not have to settle, the state allowed me to keep my case open. (NC believe it or not is pretty employee friendly when it comes to comp cases)
I am supposed to get my end of healing report and final rating on Oct 30, just a week from my 12 month mark of my surgery. At that point my lawyer will start working on the settlement part, in NC there are so many way to settle. I can elect to settle to keep my medical active.
Also as far as working, well that is a tricky one. I recently completed my FCE. I have been given perm work restrictions. I am supposedly able to work. But only 4 hours a day, with sitting, standing and walking limited to certians amounts of time with in that 4 hours. Until I find an employer willing to work with those restrictions and my doctor signs off on that, I will contiue to recieve my weekly check. Now this is NC law, each state may vary.
You and your husband have alot to think about, and you want to make sure you make the right decision. Overall I would be scared to just settle for 20,000-25,000. There are so many cost involved that can just pop up other then the surgery and again, what if something is needed after the surgery?
Keep in mind if your husband has been out of work for 5 consecutive months he may qualify for Social Security Disabiltiy even if he gets WC.
I agree that you should not settle for $20,000 in medical expenses. Ask them for justification of the amount. $20,000 will barely get you in the door for an appendectomy let alone furture spinal surgery.
