This is absolutely shocking to me. Had my ACL replaced in the UK privately about 8 years ago (no health insurance, paid out of pocket). Total cost was £3000 (+ £600 for initial scan). I could have got it done for free on the NHS but it would have messed up my term time at university.
Like the OP I had meniscal tearing too so more or less directly comparable. (Although obviously 8 years is probably a long time in medical devices so worth bearing in mind).
To put in perspective, that is approximate the same total cost (~$5000) as just _one_ of the pieces of equipment ("Cannula Fast Fix CVD") that the OP lists.
It's one thing if doctors are more expensive because they have to carry higher insurance charges to protect against negligence lawsuits, etc, but that the equipment alone is multiple times the cost seems crazy.
Similar to my experiences as well. I once compared the price of a knee MRI scan across several countries by calling folks I knew.
This is why I was dumbfounded by the call for "innovation" in medical industry at the end of the post. There's plenty of innovation is going on, it's the corruption and extortion we're looking at here: $60K were simply extorted from a person in pain.
I got my ACL replaced in Argentina and the cost including rehab was about U$S 3000 having one of the best insurance companies (about 120 U$S a month). If I wanted to use the public care, it could probably cost almost nothing.
It always amazed me that in the US the health of a person is not a right and if you get hurt doing anything you have to pay huge fees.
There are debates about how much "defensive medicine" adds to the cost, but those aren't all that relevant here since the costs presented are exclusive of additional tests, etc.
We hear about medical tourism from the US to India, Thailand, etc., but with these kinds of price discrepancies between the US and UK private practices, I wonder why there aren't more Americans who go to the UK for surgery?
We don't really have any price signals for the vast majority of our health care system, when in reality only a tiny minority of it is hard to price (emergency care is hard to price).
One point on disposing of fancy, potentially reusable, tools: We do more than a little precision machining in our lab. When a job matters, the shop buys new tooling. It's lower in cost, especially time, than verifying that a tool is sharp and correct.
At first, it seems wasteful to throw away a once-used tool, but if all you do is critical work, you must be certain that your tools are reliable and correct. Once you have a complete set of nice hand-me-down spares squirreled away for coarse work, any subsequent used tools go in the recycle bin.
For the computer-inclined, this practice is no different from taking a perfectly functional linux installation you've used for a little while for a side project and using it on a mission-critical task. It's easier and more reliable to reformat and reinstall than to inherit whatever curiosities might emerge from the past.
To be fair, you're doing exceedingly delicate machine and test equipment manufacture. The machine shops I know will buy new tools as needed, but reuse them on large job runs--and throw them out once they lose tolerance.
Something like the $900 knife in the article is/could be a mass-produced stamped piece of metal, perhaps sharpened on-site or at the factory; unit cost for that should be easily less than $10.
In the case of medical equipment, the gold standard to prevent contamination from previous patients' biomatter is to use new equipment each time. There's a demonstrably lower rate of infection than even if the equipment is cleaned to approved standards. I believe I should be able to find the paper I read discussing a while back, if you'd like.
Interesting read, and a valid criticism of the costs associated with ACL repair in the US.
It would be nice to know, however, how much your insurance company actually paid for the procedure. There's probably a large discrepancy there.
My own thoughts are that if there were a true free market for healthcare, with insurance only for real medical emergencies, the costs of a lot of these services would drop, including physician fees, equipment etc. Most of the population would not, and likely could not, pay 68,000 for an ACL repair, which would leave medical providers the option of 1) lowering prices substantially or 2) being out of work. Having put ourselves on high deductible health plans, we are super vigilant now about how we spend our healthcare dollars. And having realized the impact of this, since we are medical providers ourselves, we are now transitioning to a model where we are not participating with many insurance plans, but our fees will be completely transparent - published online - and fairly reasonable (I think).
"with insurance only for real medical emergencies"
You then have people putting off preventive care, tests etc and then you have to cover a bigger problem down the line.
I'll give you an example. You are a landlord with a tenant and you tell the tenant "you have to take care of minor repairs I will cover anything major". As a result they don't do normal maintenance either because they forget, don't care, who knows. Then because of lack of that maintenance the compressor fails on the HVAC and you end up having to replace a unit. Good luck with trying to tie that to the lack of maintenance. Or saying you won't cover it.
You're right, there is a discrepancy and I didn't think to put it in the article.
I couldn't find the doctor's charges on-hand, but the total cost for the facilities/drugs/equipment was $48,851.82. The insurance ended up paying $14,742.88 of that post-adjustments.
There's a slow trend toward doctors not taking insurance. A few of the higher profile cases have seen private practices reduce their prices between 50% and 80%, while still making a very healthy profit. For those that need charity care, they're actually able to provide it due to having a huge block of resources (time and money) not being tied up dealing with insurance claims.
I commend your move toward transparent prices for the services you provide in the medical industry.
When I was in college, I couldn't afford health insurance (no parents + financial aid does not cover it). I played rugby (generally not the safest sport) for two years, in addition to playing pickup basketball all four years. I very fortunately did not sustain any major injuries.
Six months after graduating (and getting a job with health insurance), I tore my ACL while playing pickup basketball. The costs were as insane as outlined in this post, but, again, I had health insurance. However, to this day, I'm horrified at the thought of what would've happened if I'd sustained the injury in college when I didn't have health insurance. Shame on me for putting myself in those sorts of situations, but it feels like there's something wrong when the penalty is so harsh.
You wouldn't have paid anything like $68k. As mentioned in the article, those prices are inflated for charging the insurance company, who in turn negotiates a much better actual price. Similarly, the hospital would have likely worked out a better deal with you. Or, if you qualified (and it sounds like you would have), then Medicaid would have initially picked up the tab and they would have negotiated a better deal for themselves.
In none of these scenarios does anybody actually pay the made-up $68k number.
The most useful aspect of this article is the pie charts and line-item comparisons. Ignore the dollar amounts themselves. Why? Because almost no one pays that. Why?
- In California, MediCal (state-wide health insurance safety net) pays about 20% of the cost (not price) of treatment for those without insurance. So if a surgery costs $10k, MediCal says "Here's your $2k. That's all you get."
- Nationwide, Medicare pays something closer to 90%. Much better, but still a loss to the hospitals.
- Insurance companies negotiate with hospitals, but (from what I've heard) generally pay 115-125% of the cost, giving hospitals a 15-25% margin. Certainly better, but not necessarily making up for the above.
- Some patients with no insurance, especially at major academic medical centers, are rich folks looking trying to get the best care in the world for something particularly complicated. UCSF in my neighborhood even has an in-house Saudi liaison for Saudi royals. These folks pay the full rate, which may represent an enormous markup, which does help subsidize the care of the top two categories.
For those without insurance, who don't have the money to pay the full fare (meaning you're not a foreign prince or similar), you're going to get freaked out by the bill, which is based on the last category. But in reality, the moment you ask a billing person about the costs, you'll almost always get knocked down into the insurance rate tier, just for asking. Show proof that you have next to nothing, and you could get well down into MediCal levels.
In order to get the ultra-rich to subsidize the patients that generate the loss, the price card needs to be high. Really high. So they give breaks to everyone else, since you can't do it the other way -- "Oh, you look rich, so we're going to charge you double the rate sheet."
This doesn't happen in community hospitals quite as dramatically, since they don't have the ability to handle the crazy conditions that will result in the high-revenue customers. So their rack rate for an ACL will be at the low end, while the academic medical centers that offer the $2MM neurosurgery will have rack rates for every procedure on the high end.
Is it messed up? Sure. But does it mean that normal people are paying $65k for this ACL procedure? Usually not.
This is true, but often the discounts aren't as steep as you'd think. I had a mitral valve replacement a couple years back (at age 29, due to a one in a million condition), and the insurance company was billed ~350k for the surgery + recovery in hospital. Even after their discounts, the total still came to $~250k (this is not the normal price - I had a complicated recovery, and spent an abnormal amount of time in the cardiac ICU). I, however, only had to pay ~$4,500 or so (high-deductible plan).
1) You can't turn an operating room immediately. A 1hr surgery requires significant prep time _AND_ cleaning time. These rooms are used for many different kinds of surgeries — changing everything takes time. To make matters worse, each surgeon has their own preferred set up, and it needs to match that.
2) All medical supplies are expensive in part because your body is pretty sensitive, and you need to be careful about what's in there, but also because doctors almost always have _COMPLETE_ control over what equipment they use ... including screw and tool brands. This means that hospitals have little-to-no leverage to get lower prices. This is particularly true for implants & other complicated equipment.
One thing to be aware of in how all of this stuff works; oftentimes medical billing codes don't map 1:1 to exactly how things work in the hospital, so the medical staff puts together a statement of everything they did, and then the billing staff (approximately) maps it to billing codes.
This means that they'll overshoot on some codes to make up for other acts and overhead that doesn't have an exact billing code, and every medical provider has different places that they'll overestimate, and by different amounts.
Additionally, as most people know, the billed amount is usually FAR in excess of what the insurance company actually pays.
I'm not in the industry so I may be off base here, and someone who is can correct me, but I just finished Oreilly's excellent ("Hacking Healthcare") which is about how patient services and billing work.
His expense report comes back from accounting with everything approved except the umbrella. He appends a note to the report explaining that the umbrella was destroyed in the line of duty and resubmits. Back comes the expense report, with a rather severe note from accounting to the effect that umbrellas are not on the list of allowable expenses.
...Our frustrated manager tears up the old report, then sits down and fills out a whole new form: $3.94 for lunch, $12.75 for laundry charges, and so forth. Which he sends to accounting with a note attached: SEE IF YOU CAN FIND THE UMBRELLA NOW!
I had mallet finger once and they coded it as a broken bone with the associated costs. They wanted to charge me for a full broken bone and typical time spent with hundreds of dollars of costs when all the doc did was spend 5 minutes, give me a plastic splint and tell me to not bend the finger for 8 weeks.
After many phone calls I finally got someone on the phone who realized how idiotic the code was and changed it to something more reasonable to the service rendered.
I was expecting this to be about Access Control Lists being slow or requiring more complex security reasoning (vs owner/group/other). It's not, it's about health care and injuries and something that's part of your knee.
(I am slightly hesitant to publicly share info like this, but what the heck...for science!)
I tore my ACL 1.5 years ago playing soccer, and went through a similar surgery as the OP at NYU Langone Medical Center in New York. Interestingly, my final bill for the surgery (including the same things as the OP) was almost the same - $67k and change.
However, more importantly, the actual amount paid to the doctor/hospital etc. was $18k, of which I think I had to pay around $2k, insurance covered the rest. So while the sticker price might be $67k, the actual cost is significantly lesser. In the bills that I saw from my insurance company (BCBS), for each line item, they would have a column for "Allowed Amount" or something like that which generally varied between 20-30% of the billed amount.
On a different note, I don't whether the cost would have been the whole $67k if I was uninsured. I hope not. But if yes, that's really punitive to the people who can least afford it. For that matte, even a 18k cost is prohibitively expensive for someone who cannot afford insurance.
The way understand it, yes, the uninsured person would receive the $67k bill, but can then go and negotiate to lower the amount payable. Insurance companies just did that negotiation beforehand and have a standing agreement with the provider. All of this reeks of huge inefficiencies to me. There are people at both the insurance companies as well as at every health care service provider whose full time job is to negotiate rates with each other?
Yeah, I wouldn't recommend this route, either. I read an article in The New Yorker about body parts harvested from cadavers that were used in transplants. The parts were way past their harvest-by date. This was discovered, at least partially, by someone having an ACL transplant from one of this bad parts, and the recipient of the bad part died from bad infection due to a mold on the tendon.
The lack of controls on that business forever made me wary of using cadaver parts for transplants.
The lack of controls on that business forever made me wary of using cadaver parts for transplants.
I didn't know that, but cadaver parts freak me out so when I had my ACL done I did the standard patellagraph. If I tear the same knee again I'll have to go cadaver or hamstring, but hopefully that never happens (knock on wood). The problem with the hamstring is it never quite heals as strong.
As an aside, pro-athletes typically go cadaver because the time to heal can be quicker. They probably aren't getting bad ones though.
ACL stands for Anterior Cruciate Ligament. (In case I'm not the only one who didn't know and was surprised to see this was never mentioned in the article or the comments.)
I had ACL & torn miniscus surgery 16 months ago and live in Canada, here are my experiences (excellent breakdown btw). It changed my life in many ways, but that's another story.
Though surgery is voluntary and I injured it playing soccer, the operation is covered by Medicare (which is a mandatory $64/month as I am self-employed).
So not including opportunity costs for missed work and time for pre and post-op doctor's visits (about 8 of them), my costs not covered were:
- Post-surgery pain killers: $30 for T3's for a week. I refused the Percocet's, although the pain was bad I could still sleep.
- Physio visits. They'd have you 2-3X per week for the whole duration if they had it their way, at $70 per appointment. I can't afford that, so I went once a week for three months = $840.
- I declined the $900 custom knee brace that helps you get back playing sports sooner.
- Rental of crutches for two months $25
And crutches are NOT as easy as I once thought, when you'd hop around on hour friends crutches for a few steps. I'm pretty fit, but a few blocks in them has you sore and sweating. Take care of those knees!!
I also had my ACL replaced (hamstring autograft), in SF, about 2.5 years ago after a basketball injury.
I'm pretty sure these prices are starting 'list' prices, whereas the negotiated/'allowed' cost that you and your insurance company actually wind up paying tends to be 1/2 to 1/3 these numbers.
My surgery was also about 3 months after the injury, which isn't optimal. It took me a few weeks to see a doctor, I didn't like the 1st doctor I saw, and by the time I'd settled on a preferred one, I needed 6 weeks of physical therapy to undo some of the post-injury weakening of surrounding muscles. (Since there's also atrophying due to surgical damage and post-surgery immobilization, it's best for recovery for the muscles to be as strong as possible going in. So diagnosis/surgery ASAP after injury, with muscles nearly at their pre-injury best, is preferred... if you suspect your ACL is torn see a doc quickly!)
Depends. An ACL tear can feel better on it's own after a few weeks assuming you don't go running into any hard direction changes. Many docs would prefer pre-hab prior to surgery in order to get maximum flexibility and strength for every patient, but most insurance will not pay for it.
I saw a doctor right away, but they still wanted to wait a month until ACL reconstruction surgery (cadaver achilles heal) so that all the mobility could be returned before the operation to help speed up the post op rehab.
For comparison, the full cost of a hernia repair (http://en.wikipedia.org/wiki/Inguinal_hernia_repair) in a private hospital in Poland is below $1500. Sure, this is a much simpler procedure than the OP's one, but still -- it involves an operating room, a surgeon, an anesthesiologist, assistants/nurses, and 2 days of hospital care. I don't imagine the materials are much different to the ones used in the US.
Even accounting for the lower cost of labor, the prices in the US are insane.
I don't know the statistics overall, but in my case the comparison of the inguinal hernia repair is even more damning: I'm positive it was more costly, but to add insult to injury, it (my hernia repair) was done as an outpatient procedure.
Although I am not a doctor (just a patient), if anyone tries to pitch you this as a good idea, run. The effective recovery time was insane, and not to mention the pain/temporary disability (also insane). An inpatient stay wasn't even offered, but in hindsight it shouldn't have even been optional.
By contrast, an unrelated abdominal surgery a few years later, despite being a much more involved procedure, had a much faster recovery. (10 day inpatient stay + probably 5 days of that with some physical therapy.)
Health care costs are a secondary issue to me, right behind health care quality. Unfortunately, I don't think either can be fixed unless they are entirely divorced from each other.
I'd be interested in seeing this analysis using what the actual final cost incurred was (normally the fees you are shown are negotiated down by your insurance company to the amount they actually pay).
I am actually 4 months out from my own ACL surgery, tore mine skiing and one thing the OP forgets to mention is many insurance will never pay that $60k as they have pre-negotiated rated with the hospitals and doctors. My surgery was done in SF (not the cheapest city in the world..) and according to the bill came out to just over 100k, but, my insurance paid 17k. What happen to the rest? Well I assume it was just inflated costs that the hospitals adds to the bill so the insurance can negotiate down.
This is amazing to me. I am from Australia and did my ACL when I was 15, and the cost was around $3000. It was an overnight stay in hospital, the only costs not incurred for the actual surgery and operation were MRI's and physiotherapy. How that could cost 20x the amount in America, I could not possibly fathom.
It is always a struggle for me to understand how health insurance is such a major expense in America, but when relatively routine surgery such as an ACL repair costs that much, things are put into perspective.
I had this exact same surgery 7 years ago after tearing ACL/meniscus playing basketball. Patellar tendon graft FTW! (I joke that real men donate their own tissues)
For me, the ACL has been perfect ever since. Wish I could say the same for my meniscus and cartilage - I subsequently tore my meniscus 2 more times (each time in a non-vascular area so they just sanded it down, no sutures like you had), and then 5 years later I tore a chunk out of my articular cartilage that had probably been weakened years before when I did my ACL.
That led to an OATS procedure where they took bone plugs from a non-weight bearing part of the knee and transplanted them in holes bored where the lesion was. That last procedure was pretty fun as it entailed 6 weeks on crutches, non-weight bearing, during which period my wife and I had our first kid (yay for timing!).
Anyway, that just to say hang in there (I imagine your rehab is pretty much over by this point, but it probably still aches?), and I hope your ACL graft (good call with the patellar) holds up as well as mine and your meniscus better. Oh and enjoy the achiness that comes with changing weather. I was rather amused that that apparently is a real thing. :)
As a side note, medical insurance much like construction is a 'cost-plus' industry. The insurance companies actually have incentive to make prices go up.
For example, insurance companies are required to spend 80% on medical expenses. So if cost of an ACL surgery skyrocketed $100,000 then, they would make $20,000 off of it. Instead, they only made about $14k off of Calvin's surgery.
I ruptured my left ACL during the final year of our college during a cultural fest (in India). It was a complete tear and required surgery to return to normal knee movement (Instability due to knee cartilages tears/injuries suck, and lead to further secondary injuries).
I had to differ my surgery for a couple of months since we had our final exams and I had to walk with a brace and avoid injury-causing activities. The surgery at one of the leading hospitals in the country cost me around ~$3000 and was completely covered by my Health Insurance, the care I received was exceptional and I could see why "Medical tourism" to India is on the raise. The costs are mostly around 1/10 of what any procedure costs elsewhere.
P.S. Incidentally, I had a freak accident a few days back and I'm positive I tore one (or many) of my ligaments in the other knee, and I had just started training to run a marathon within the next year :( (Lady luck hates my knees)
[+] [-] dbuxton|13 years ago|reply
Like the OP I had meniscal tearing too so more or less directly comparable. (Although obviously 8 years is probably a long time in medical devices so worth bearing in mind).
To put in perspective, that is approximate the same total cost (~$5000) as just _one_ of the pieces of equipment ("Cannula Fast Fix CVD") that the OP lists.
It's one thing if doctors are more expensive because they have to carry higher insurance charges to protect against negligence lawsuits, etc, but that the equipment alone is multiple times the cost seems crazy.
Mental.
[+] [-] old-gregg|13 years ago|reply
This is why I was dumbfounded by the call for "innovation" in medical industry at the end of the post. There's plenty of innovation is going on, it's the corruption and extortion we're looking at here: $60K were simply extorted from a person in pain.
It's a legislation+law enforcement issue.
[+] [-] chudi|13 years ago|reply
It always amazed me that in the US the health of a person is not a right and if you get hurt doing anything you have to pay huge fees.
[+] [-] rayiner|13 years ago|reply
There are debates about how much "defensive medicine" adds to the cost, but those aren't all that relevant here since the costs presented are exclusive of additional tests, etc.
[+] [-] apendleton|13 years ago|reply
[+] [-] unknown|13 years ago|reply
[deleted]
[+] [-] danielweber|13 years ago|reply
[+] [-] ISL|13 years ago|reply
One point on disposing of fancy, potentially reusable, tools: We do more than a little precision machining in our lab. When a job matters, the shop buys new tooling. It's lower in cost, especially time, than verifying that a tool is sharp and correct.
At first, it seems wasteful to throw away a once-used tool, but if all you do is critical work, you must be certain that your tools are reliable and correct. Once you have a complete set of nice hand-me-down spares squirreled away for coarse work, any subsequent used tools go in the recycle bin.
For the computer-inclined, this practice is no different from taking a perfectly functional linux installation you've used for a little while for a side project and using it on a mission-critical task. It's easier and more reliable to reformat and reinstall than to inherit whatever curiosities might emerge from the past.
When quality matters, provenance matters.
[+] [-] angersock|13 years ago|reply
Something like the $900 knife in the article is/could be a mass-produced stamped piece of metal, perhaps sharpened on-site or at the factory; unit cost for that should be easily less than $10.
[+] [-] MPSimmons|13 years ago|reply
[+] [-] dr_|13 years ago|reply
My own thoughts are that if there were a true free market for healthcare, with insurance only for real medical emergencies, the costs of a lot of these services would drop, including physician fees, equipment etc. Most of the population would not, and likely could not, pay 68,000 for an ACL repair, which would leave medical providers the option of 1) lowering prices substantially or 2) being out of work. Having put ourselves on high deductible health plans, we are super vigilant now about how we spend our healthcare dollars. And having realized the impact of this, since we are medical providers ourselves, we are now transitioning to a model where we are not participating with many insurance plans, but our fees will be completely transparent - published online - and fairly reasonable (I think).
[+] [-] larrys|13 years ago|reply
You then have people putting off preventive care, tests etc and then you have to cover a bigger problem down the line.
I'll give you an example. You are a landlord with a tenant and you tell the tenant "you have to take care of minor repairs I will cover anything major". As a result they don't do normal maintenance either because they forget, don't care, who knows. Then because of lack of that maintenance the compressor fails on the HVAC and you end up having to replace a unit. Good luck with trying to tie that to the lack of maintenance. Or saying you won't cover it.
[+] [-] calvinfo|13 years ago|reply
I couldn't find the doctor's charges on-hand, but the total cost for the facilities/drugs/equipment was $48,851.82. The insurance ended up paying $14,742.88 of that post-adjustments.
[+] [-] djloche|13 years ago|reply
I commend your move toward transparent prices for the services you provide in the medical industry.
[+] [-] goronbjorn|13 years ago|reply
Six months after graduating (and getting a job with health insurance), I tore my ACL while playing pickup basketball. The costs were as insane as outlined in this post, but, again, I had health insurance. However, to this day, I'm horrified at the thought of what would've happened if I'd sustained the injury in college when I didn't have health insurance. Shame on me for putting myself in those sorts of situations, but it feels like there's something wrong when the penalty is so harsh.
[+] [-] dionidium|13 years ago|reply
In none of these scenarios does anybody actually pay the made-up $68k number.
[+] [-] whafro|13 years ago|reply
- In California, MediCal (state-wide health insurance safety net) pays about 20% of the cost (not price) of treatment for those without insurance. So if a surgery costs $10k, MediCal says "Here's your $2k. That's all you get."
- Nationwide, Medicare pays something closer to 90%. Much better, but still a loss to the hospitals.
- Insurance companies negotiate with hospitals, but (from what I've heard) generally pay 115-125% of the cost, giving hospitals a 15-25% margin. Certainly better, but not necessarily making up for the above.
- Some patients with no insurance, especially at major academic medical centers, are rich folks looking trying to get the best care in the world for something particularly complicated. UCSF in my neighborhood even has an in-house Saudi liaison for Saudi royals. These folks pay the full rate, which may represent an enormous markup, which does help subsidize the care of the top two categories.
For those without insurance, who don't have the money to pay the full fare (meaning you're not a foreign prince or similar), you're going to get freaked out by the bill, which is based on the last category. But in reality, the moment you ask a billing person about the costs, you'll almost always get knocked down into the insurance rate tier, just for asking. Show proof that you have next to nothing, and you could get well down into MediCal levels.
In order to get the ultra-rich to subsidize the patients that generate the loss, the price card needs to be high. Really high. So they give breaks to everyone else, since you can't do it the other way -- "Oh, you look rich, so we're going to charge you double the rate sheet."
This doesn't happen in community hospitals quite as dramatically, since they don't have the ability to handle the crazy conditions that will result in the high-revenue customers. So their rack rate for an ACL will be at the low end, while the academic medical centers that offer the $2MM neurosurgery will have rack rates for every procedure on the high end.
Is it messed up? Sure. But does it mean that normal people are paying $65k for this ACL procedure? Usually not.
[+] [-] danjayh|13 years ago|reply
[+] [-] milesskorpen|13 years ago|reply
1) You can't turn an operating room immediately. A 1hr surgery requires significant prep time _AND_ cleaning time. These rooms are used for many different kinds of surgeries — changing everything takes time. To make matters worse, each surgeon has their own preferred set up, and it needs to match that.
2) All medical supplies are expensive in part because your body is pretty sensitive, and you need to be careful about what's in there, but also because doctors almost always have _COMPLETE_ control over what equipment they use ... including screw and tool brands. This means that hospitals have little-to-no leverage to get lower prices. This is particularly true for implants & other complicated equipment.
3) Insured people subsidize the uninsured.
[+] [-] angersock|13 years ago|reply
[+] [-] showerst|13 years ago|reply
This means that they'll overshoot on some codes to make up for other acts and overhead that doesn't have an exact billing code, and every medical provider has different places that they'll overestimate, and by different amounts.
Additionally, as most people know, the billed amount is usually FAR in excess of what the insurance company actually pays.
I'm not in the industry so I may be off base here, and someone who is can correct me, but I just finished Oreilly's excellent ("Hacking Healthcare") which is about how patient services and billing work.
[+] [-] danielweber|13 years ago|reply
His expense report comes back from accounting with everything approved except the umbrella. He appends a note to the report explaining that the umbrella was destroyed in the line of duty and resubmits. Back comes the expense report, with a rather severe note from accounting to the effect that umbrellas are not on the list of allowable expenses.
...Our frustrated manager tears up the old report, then sits down and fills out a whole new form: $3.94 for lunch, $12.75 for laundry charges, and so forth. Which he sends to accounting with a note attached: SEE IF YOU CAN FIND THE UMBRELLA NOW!
[+] [-] matwood|13 years ago|reply
After many phone calls I finally got someone on the phone who realized how idiotic the code was and changed it to something more reasonable to the service rendered.
[+] [-] tbrownaw|13 years ago|reply
[+] [-] calvinfo|13 years ago|reply
[+] [-] tsycho|13 years ago|reply
I tore my ACL 1.5 years ago playing soccer, and went through a similar surgery as the OP at NYU Langone Medical Center in New York. Interestingly, my final bill for the surgery (including the same things as the OP) was almost the same - $67k and change.
However, more importantly, the actual amount paid to the doctor/hospital etc. was $18k, of which I think I had to pay around $2k, insurance covered the rest. So while the sticker price might be $67k, the actual cost is significantly lesser. In the bills that I saw from my insurance company (BCBS), for each line item, they would have a column for "Allowed Amount" or something like that which generally varied between 20-30% of the billed amount.
On a different note, I don't whether the cost would have been the whole $67k if I was uninsured. I hope not. But if yes, that's really punitive to the people who can least afford it. For that matte, even a 18k cost is prohibitively expensive for someone who cannot afford insurance.
[+] [-] smartician|13 years ago|reply
[+] [-] dkl|13 years ago|reply
Yeah, I wouldn't recommend this route, either. I read an article in The New Yorker about body parts harvested from cadavers that were used in transplants. The parts were way past their harvest-by date. This was discovered, at least partially, by someone having an ACL transplant from one of this bad parts, and the recipient of the bad part died from bad infection due to a mold on the tendon.
The lack of controls on that business forever made me wary of using cadaver parts for transplants.
[+] [-] matwood|13 years ago|reply
I didn't know that, but cadaver parts freak me out so when I had my ACL done I did the standard patellagraph. If I tear the same knee again I'll have to go cadaver or hamstring, but hopefully that never happens (knock on wood). The problem with the hamstring is it never quite heals as strong.
As an aside, pro-athletes typically go cadaver because the time to heal can be quicker. They probably aren't getting bad ones though.
[+] [-] omaranto|13 years ago|reply
[+] [-] medell|13 years ago|reply
Though surgery is voluntary and I injured it playing soccer, the operation is covered by Medicare (which is a mandatory $64/month as I am self-employed).
So not including opportunity costs for missed work and time for pre and post-op doctor's visits (about 8 of them), my costs not covered were: - Post-surgery pain killers: $30 for T3's for a week. I refused the Percocet's, although the pain was bad I could still sleep. - Physio visits. They'd have you 2-3X per week for the whole duration if they had it their way, at $70 per appointment. I can't afford that, so I went once a week for three months = $840. - I declined the $900 custom knee brace that helps you get back playing sports sooner. - Rental of crutches for two months $25
And crutches are NOT as easy as I once thought, when you'd hop around on hour friends crutches for a few steps. I'm pretty fit, but a few blocks in them has you sore and sweating. Take care of those knees!!
[+] [-] gojomo|13 years ago|reply
I'm pretty sure these prices are starting 'list' prices, whereas the negotiated/'allowed' cost that you and your insurance company actually wind up paying tends to be 1/2 to 1/3 these numbers.
My surgery was also about 3 months after the injury, which isn't optimal. It took me a few weeks to see a doctor, I didn't like the 1st doctor I saw, and by the time I'd settled on a preferred one, I needed 6 weeks of physical therapy to undo some of the post-injury weakening of surrounding muscles. (Since there's also atrophying due to surgical damage and post-surgery immobilization, it's best for recovery for the muscles to be as strong as possible going in. So diagnosis/surgery ASAP after injury, with muscles nearly at their pre-injury best, is preferred... if you suspect your ACL is torn see a doc quickly!)
[+] [-] matwood|13 years ago|reply
[+] [-] taude|13 years ago|reply
[+] [-] jwr|13 years ago|reply
Even accounting for the lower cost of labor, the prices in the US are insane.
[+] [-] Komodo9|13 years ago|reply
Although I am not a doctor (just a patient), if anyone tries to pitch you this as a good idea, run. The effective recovery time was insane, and not to mention the pain/temporary disability (also insane). An inpatient stay wasn't even offered, but in hindsight it shouldn't have even been optional.
By contrast, an unrelated abdominal surgery a few years later, despite being a much more involved procedure, had a much faster recovery. (10 day inpatient stay + probably 5 days of that with some physical therapy.)
Health care costs are a secondary issue to me, right behind health care quality. Unfortunately, I don't think either can be fixed unless they are entirely divorced from each other.
[+] [-] timcederman|13 years ago|reply
[+] [-] zsiddique|13 years ago|reply
[+] [-] lobe|13 years ago|reply
It is always a struggle for me to understand how health insurance is such a major expense in America, but when relatively routine surgery such as an ACL repair costs that much, things are put into perspective.
[+] [-] bjhoops1|13 years ago|reply
For me, the ACL has been perfect ever since. Wish I could say the same for my meniscus and cartilage - I subsequently tore my meniscus 2 more times (each time in a non-vascular area so they just sanded it down, no sutures like you had), and then 5 years later I tore a chunk out of my articular cartilage that had probably been weakened years before when I did my ACL.
That led to an OATS procedure where they took bone plugs from a non-weight bearing part of the knee and transplanted them in holes bored where the lesion was. That last procedure was pretty fun as it entailed 6 weeks on crutches, non-weight bearing, during which period my wife and I had our first kid (yay for timing!).
Anyway, that just to say hang in there (I imagine your rehab is pretty much over by this point, but it probably still aches?), and I hope your ACL graft (good call with the patellar) holds up as well as mine and your meniscus better. Oh and enjoy the achiness that comes with changing weather. I was rather amused that that apparently is a real thing. :)
[+] [-] bayton|13 years ago|reply
As a side note, medical insurance much like construction is a 'cost-plus' industry. The insurance companies actually have incentive to make prices go up.
For example, insurance companies are required to spend 80% on medical expenses. So if cost of an ACL surgery skyrocketed $100,000 then, they would make $20,000 off of it. Instead, they only made about $14k off of Calvin's surgery.
[+] [-] ameen|13 years ago|reply
I had to differ my surgery for a couple of months since we had our final exams and I had to walk with a brace and avoid injury-causing activities. The surgery at one of the leading hospitals in the country cost me around ~$3000 and was completely covered by my Health Insurance, the care I received was exceptional and I could see why "Medical tourism" to India is on the raise. The costs are mostly around 1/10 of what any procedure costs elsewhere.
P.S. Incidentally, I had a freak accident a few days back and I'm positive I tore one (or many) of my ligaments in the other knee, and I had just started training to run a marathon within the next year :( (Lady luck hates my knees)