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Old 03-22-2011, 08:20 AM   #1
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Discectomy cost

Hi,
I'm considering an out-patient discectomy for L5-S1 herniation. I'm a student, so I don't make a lot of money, but have insurance. The insurance covers 80% supposedly, but I don't know if that's 80% of the surgeon fee, without anaestheist, etc. I have a few thousand saved (rainy days such as they are). I tried to ask the surgeon's financial dept what out of pocket might apply to me, but they said they couldn't tell me because they didn't know this, that, and the other thing about the procedure. I know costs vary by region and I know that insurance will only pay part of it. I'm just looking for ballpark figures. Did it run $2000? $5000? $10000? Are you in a big city? I understand financial info is sensitive to people, so any answer is appreciated.

 
Old 03-22-2011, 02:52 PM   #2
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Re: Discectomy cost

[COLOR="Navy"]You might have been luck if you ask at the hospital what the general cost might run for the porceedure, including the anesthesia. I have found that the anesthesiologist tends to bill separately-and that can be a chunck of change in of itself. The surgeons' bill might be sperate on top of the hospital bill, but they might be able to give you a ballpark idea.

You might ask your surgeon's PA or nurse if she could help you get a guess-ta-mite. Tell her that you are seiours about the surgery, but your insurance only covers 80% bla bla bla. You get the idea. If you can get someone in the office on your side you might get a sort of answer. I think the accounting division has been told not to tell...Perhaps there was a lawsuit. Who knows. But if you tell them it's the differnce between having the surgery or not....

You may not get many answers here. I had a three level fusion, followed by my back breaking and being back in surgery to be fused from T9-sacrum. I never saw a bill. It may be that way for alot of folks. It's not that I wouldn't share it with you, but I truly don't know!

good luck![/COLOR]

 
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Old 03-22-2011, 04:45 PM   #3
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Re: Discectomy cost

I had a L5-S1 partial discectomy and laminectomy done in Dec. 2009 and I believe the total cost billed to my insurance was around $10K. Included one night in the hospital.

 
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runagainsoon (03-23-2011)
Old 03-22-2011, 04:48 PM   #4
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Re: Discectomy cost

It might make sense to contact your insurance company to find out if they have an out-of-pocket maximum that you pay. Many 80/20 insurance programs pick up everything for the rest of the year after you pay out $4,000-$5,000 on your end.

Also, make sure you are eligible to have back surgery with your insurance. Sometimes insurance plans for students have limitations, exclusions, or pre-existing conditions, so contact your insurance company to clarify these issues.

Often the hospital, surgeon, anesthesiologist, and hospitalist will bill separately. If you ask the costs, you might just be given one of these costs, so be sure to find out just what you are being quoted.

For a simple microdiscectomy, it will vary by region and by surgeon. I would guesstimate the surgeon fees to run around $3,000-$5,000 for an uncomplicated surgery, and the hospital costs to run around $12,000-$15,000 (this covers the operating room, hospital room, hospital staff, drugs, food, etc. while hospitalized for 1-2 nights). Add $1,000 for the anesthesiologist and about $700 for the hospitalist. The fee for a surgeon typically covers any post-op office visits for 90 days.

If you have complications, of course the fees could go much higher and additional tests may be needed. One of my surgeons told me complications occur in about 1-2% of all simple spine surgeries.

Have you tried all conservative options already? How long have you been dealing with this pain? Often your body can reabsorb some of your disc with conservative therapies, but it can take months or years for it to happen.

Also, your insurance company negotiates a discount with any providers they allow, which is usually around 20-35% off the normal price, so this will also affect how much your surgery would cost.

 
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runagainsoon (03-23-2011)
Old 03-22-2011, 10:40 PM   #5
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Re: Discectomy cost

[QUOTE=twohands;4713012]It might make sense to contact your insurance company to find out if they have an out-of-pocket maximum that you pay. Many 80/20 insurance programs pick up everything for the rest of the year after you pay out $4,000-$5,000 on your end. [/QUOTE]
Excellent suggestion twohands. Most policies do have a cap on OOP expenses for a calendar year.

[QUOTE=twohands;4713012]Often the hospital, surgeon, anesthesiologist, and hospitalist will bill separately. If you ask the costs, you might just be given one of these costs, so be sure to find out just what you are being quoted. [/QUOTE]
Very true... I received a separate bill from my NS, one from the hospital. I didn't get a seperate one from the anethesiologist, not sure why? Maybe they were an employee of the hospital as there was a line on the hosptial bill specifically for anesthesia. But some other expenses to keep in mind are that you will certainly need a pre-op physical and lab work (blood tests/urinalysis). I don't know how much you would have to pay of those expenses but just something to keep in mind when trying to figure out the final costs.

[QUOTE=twohands;4713012]For a simple microdiscectomy, it will vary by region and by surgeon. I would guesstimate the surgeon fees to run around $3,000-$5,000 for an uncomplicated surgery, and the hospital costs to run around $12,000-$15,000 (this covers the operating room, hospital room, hospital staff, drugs, food, etc. while hospitalized for 1-2 nights). Add $1,000 for the anesthesiologist and about $700 for the hospitalist. The fee for a surgeon typically covers any post-op office visits for 90 days.[/QUOTE]
I think this is a great starting point as a rough idea. However, I was hospitalized for 2 nights and never once saw a hospitalist. My NS and his PA attended to all of my tests, visits, etc. I thought hospitalists were used more when a DR did not have admitting privileges where a surgeon would clearly have that power. I could be wrong though...

[QUOTE=twohands;4713012]If you have complications, of course the fees could go much higher and additional tests may be needed. One of my surgeons told me complications occur in about 1-2% of all simple spine surgeries.[/QUOTE]
My surgery was SUPPOSED to be out patient. However, I was admitted for pain management and observation for potential complications due to excessive pain. Guess I'm that 1-2%.

[QUOTE=twohands;4713012]Also, your insurance company negotiates a discount with any providers they allow, which is usually around 20-35% off the normal price, so this will also affect how much your surgery would cost.[/QUOTE]
Very True!! My NS billed I believe 3 or 4 grand but was only alloted just under $800. That is a huge difference.

I'm not sure if you are having a microdiscectomy, but It seems that in general most of those are performed on an out-patient basis which is much more cost effective.

I have had 2 microdiscectomies (first one was 10/10 and the second was 2/11). The first one all inclusive was around 10 grand. That included pre-op and everything. And was successfully done on an outpatient basis. The second surgey was scheduled as outpatient but I ended up being admitted for two nights. The second surgery (a redo because I re-herniated the same disc) also included a hemilaminectomy, facetectomy, and foraminotomy. I had an MRI performed in the hospital the day after surgery (incl in the hospital bill) and the total for that one was a bit over $15 grand, I believe. This was at a private (not teaching) hospital. Not sure if any of this helps you, but it is the best I can share regarding my experiences.

Best of Luck to you with whatever you decide. I know it is very difficult trying to decide what is the best course of treatment along with the doctor.

 
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Old 03-23-2011, 06:28 AM   #6
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Re: Discectomy cost

hudson07,
Thanks for your information. That's helpful!

 
Old 03-23-2011, 06:42 AM   #7
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Re: Discectomy cost

twohands,

All the financial/insurance information you gave me is great. They should make your comment a sticky for people who have to consider the financial implications of surgery.

EDIT:I called my insurance and they said that it wouldn't be covered. Now that I've got an idea of the costs, I know I can't cover all of those out of my own pocket. I'm glad you prompted me to check before even starting the ball rolling.

As far as conservative treatment and all, it's going on 16 months. There has been no change at all in the pain. I've been to a physical therapist. I got one epidural and that had no effect at all. I've tried decompression. I spend a lot of time at my desk, but I make sure to get out and walk and go to the gym daily. I try to stretch a little bit, carefully, but that's still hard to do.
I used to be in really good shape and I'm in decent shape I think for the condition (but not great shape obviously), but I'm tired of 24r/day pain. I don't want this condition to hamper me in my search for work when I graduate

Last edited by runagainsoon; 03-23-2011 at 07:34 AM. Reason: extend reply

 
Old 03-23-2011, 06:46 AM   #8
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Re: Discectomy cost

ibakeandpray and hausofmouse,

I appreciate the replies you gave me. I've spent at least a few days thinking about it and it's getting distracting, since I have a lot of schoolwork. Hope that your recovery goes well, hausofmouse.

 
Old 03-23-2011, 09:43 PM   #9
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Re: Discectomy cost

[QUOTE=hausofmouse;4713231]Excellent suggestion twohands. Most policies do have a cap on OOP expenses for a calendar year.


Very true... I received a separate bill from my NS, one from the hospital. I didn't get a seperate one from the anethesiologist, not sure why? Maybe they were an employee of the hospital as there was a line on the hosptial bill specifically for anesthesia. But some other expenses to keep in mind are that you will certainly need a pre-op physical and lab work (blood tests/urinalysis). I don't know how much you would have to pay of those expenses but just something to keep in mind when trying to figure out the final costs.


I think this is a great starting point as a rough idea. However, I was hospitalized for 2 nights and never once saw a hospitalist. My NS and his PA attended to all of my tests, visits, etc. I thought hospitalists were used more when a DR did not have admitting privileges where a surgeon would clearly have that power. I could be wrong though...


My surgery was SUPPOSED to be out patient. However, I was admitted for pain management and observation for potential complications due to excessive pain. Guess I'm that 1-2%.


Very True!! My NS billed I believe 3 or 4 grand but was only alloted just under $800. That is a huge difference.

I'm not sure if you are having a microdiscectomy, but It seems that in general most of those are performed on an out-patient basis which is much more cost effective.

I have had 2 microdiscectomies (first one was 10/10 and the second was 2/11). The first one all inclusive was around 10 grand. That included pre-op and everything. And was successfully done on an outpatient basis. The second surgey was scheduled as outpatient but I ended up being admitted for two nights. The second surgery (a redo because I re-herniated the same disc) also included a hemilaminectomy, facetectomy, and foraminotomy. I had an MRI performed in the hospital the day after surgery (incl in the hospital bill) and the total for that one was a bit over $15 grand, I believe. This was at a private (not teaching) hospital. Not sure if any of this helps you, but it is the best I can share regarding my experiences.

Best of Luck to you with whatever you decide. I know it is very difficult trying to decide what is the best course of treatment along with the doctor.[/QUOTE]

All I do know is that many American hospitals are offering 50 percent off for Canadian patients now as business is really slow for operating staff. Better a small profit than none at all, and the skills are kept up.
James

 
Old 03-23-2011, 10:33 PM   #10
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Re: Discectomy cost

[QUOTE=james079;4714097]All I do know is that many American hospitals are offering 50 percent off for Canadian patients now as business is really slow for operating staff. Better a small profit than none at all, and the skills are kept up.
James[/QUOTE]
Very Interesting to hear this....
While I'm not saying this is not accurate, I find it interesting and maybe a regional thing. When I first saw my NS back on Sept 22, '10, my rupture was so bad, he told me I was at the top of 'HIS' surgical triage list (barring someone coming in after me with a lifethreatening circumstance). I remember this conversation explicitly as the comment really scared the hickey pickey out of me! He wanted to have me in the O.R. within a day or two. But due to his already scheduled surgeries and O.R. availibility, I wasn't able to get a surgery date until Oct 8. He had a cancellation on 10/5 (the officer mgr called me the afternoon of 10/4) and I was moved forward. For my redo, he decided at my appt on 12/21 that I needed the redo, and it was scheduled for 2/2/11. I guess he's not hurting for business!! LOL
And getting an office appt is no easy feat either! Although he has me call his office mgr and she double books me in where needed. My first appt was going to be 10/21 for a phone call made on 9/20!!! I called my ortho (who was referring me to the NS). He had requested my first MRI and had rec'd the report. He said there was no way I could/should wait that long and called the NS himself. The NS saw me between surgeries just a few days later after talking to the ortho.
And this hospital didn't seem to be hurting for patients either, lol. I got the last bed in the ortho unit the night I was admitted. I had to wait better than 6 hrs for the other patient to be discharged so I could have their bed. Interesting how busy some hospitals seem to be versus others that don't seem to be busy enough...

Also the figures I quoted were what the ins co paid, not what was billed. We have a PPO but if the DR/facility/etc are a participating provider, they cannot balance bill you. What was billed was MUCH higher. The NS billed $5,100 and got just under $1,000 for the surgery. BIG difference... I went onto the ins co's website last night after posting and looked to see what had been paid in claims last month. I was astonished at the billed versus paid costs. The hospital portion was paid exactly as billed minus my copay. Everything else was quite pro-rated.

 
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