Surgery costs? - Spinal Cord Disorders Message Board

poopoopadoop · 06-09-2007, 07:16 PM

Just got my bill for a one level ACDF - donor bone c5-6. The surgeon fees alone (not hospital or other drs) were (get ready for this...) $59,000. He was out-of-network with my insurance. I heard my insurance paid $38,000. I am afraid of how much I will be responsible for.

On a good note, the surgery really did help me.

Lisa

neckhurtin · 06-10-2007, 08:45 AM

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settingsons · 06-10-2007, 12:29 PM

That cost sounds outrageous. Here in the UK if you go private a NS charges about £1500 (about $3000) for the single-level ACDF operation and about £200 ($400) for consultations. With hospital fees, surgeon fees, anaes fees, etc. my ACDF cost about £9,000 ($18,000).

SpineAZ · 06-10-2007, 02:49 PM

Be sure to get a copy of the exact plan under which you are covered. Usually there are a few different components (1) in network deductible (2) out of network deductible (3) in network out of pocket max (4) out of network out-of-pocket maximum.

This is in addition to how your plan works. Many are 80/20 in-network and 70/30 out-of-network. That means out of network the insurance company will pay 70% and you are responsible for the remaining 30% BUT only to the maximum detailed as your "out-of-pocket" maximum.

So there are a ton of variables. If you get a copy of the plan you'll know what to expect AND you can make sure the Insurance Company complies with the plan as well.

BobM · 06-10-2007, 05:02 PM

I have had ACDF two times (2004 & 2005), and each time the totals that were billed to the insurance company were approx $70,000. My surgeon & the hospital were both 'providers', and the totals that insurance paid were something like 50 to 60% of the billed amounts.

Since my health insurance is through my employer, the insurance company can change from time to time. This doesn't concern me for routine health care things (physicals, ear infection, etc) but I don't like 'starting over' with a new medical team just because my company got a better deal this year from a different insurance company. My surgeon says he would 'accept' the amount paid for an 'out of network' provider by my insurance company if I ever need that because my company changes insurance plans. I still have some bad discs and it's likely I'll have another surgery down the road.

It might be worth discussing this with your Dr., maybe he would offer some relief on at least part of the amount insurance didn't cover - just a suggestion.

Good Luck!
Bob