The statements are finally arriving for my hip replacement surgery in June. So far, including surgeon fees, anesthesia, lab, physical therapy, medications and blood, X-rays and scans, “medical equipment” (we’ll get to that later) and room/board for 10 days, the grand total is hovering near $120,000. Does this seem a bit excessive to anyone? The “medical equipment” alone is $46,000! WTF is that all about, an IV pump and some oxygen ain’t adding up in my book. My shitty insurance is threatening to deny that part of the claim unless the hospital will submit all sorts of documentation. And when that doesn’t happen (or if it happens, but I’m not really optimistic about the outcome), won’t the hospital come after me for payment??? Of course, I have attempted to request an itemized
statement, but I had to leave my info on an answering machine, and frankly I would feel more comfortable being able to talk to someone alive about this.
Does anyone know what happens in cases such as this one? I would think that the hospital wants to collect their money and would try to coopertate with the insurance company, but anything goes these days. I haven’t received any bills from the hospital yet, but if they send me a bill for $46,000 I am gonna beat someone to death with my titanium hip.
Beckwall–keep insisting on the itemized statement. If your insurance coverage is not a HMO like deal you may be left “oweing $$” that the hospital agreed to writeoff on other patients. Match up as much as you can the items billed and items paid. Keep pushing for information.
I used a “contracted” doctor and hospital for my x-rays but there was still a “co-pay” but it had been collected prior to the service and then the hospital tried to bill me for it again. When I sat down and did the math and then wrote the hospital showing my insurance paid such & such and the agreed upon discount was so-so and the difference had been collected in full prior to service, that by my calulations the hospital owed me-TA-da the dunning letters stopped. Didn’t get a check but I wasn’t hounded for payment on something that had already been paid.
My point is, as dull as it is, keep the paperwork and track the math. Hospitals can be vicious and in error at the same time.
Ditto on the above. Keep copies of everything. If the insurance or the hospital requests some document or information from you, send it in such a manner that you get a return receipt.
Even assuming the most honest and ethical hospital and insurance company, both can make mistakes.
I had a hospital serve me with a court summons over $2000 that the insurance company claimed to have paid already. Turned out they only SAID they paid it, never actually sent the check. Ooops. They also kept claiming they didn’t have certain documents, when in fact these had already been sent. They stopped “losing” items when I started sending them registered mail.
In addition, sometimes hospitals, when questioned, will reduce the bill. I’ve had the experience of having a bill reduced for one of my daughters, who had no insurance at the time, because the charge was in excess of the “reasonable and customary” charges. I got that tip from an insurance worker.
That 46k “medical equipment” might be the actual titanium replacement joint. I remember when I had my replacement 10 years ago that I was shocked at the cost of the replacement joint itself. Be sure to ask for an itemized bill.
beckwall, doper, a man barely alive. Gentlemen, we can rebuild him, we have the technology. We have the capability to make the worlds first Bionic man. beckwall will be that man. Better than he was before. Better. Stronger. Faster.
Beckwall is the $120,000 Doper. (cue cool sound effects and video of beckwall jumping over stuff)
Insurance biller, here. The insurance company will likely ask the hospital to submit an invoice for the $46k in “equipment”. The hip may be considered “equipment”.
Call the hospital’s billing department and ask for an itemized bill.
If the insurance company is contracted with the hospital, they won’t come after you except for co-pays, deductibles, and co-insurances. As long as the procedure was properly pre-certed, it’s up to the hospital and the insurance company to fight it out. If your insurance company is not contracted with the hospital, you could pay a higher amount. Check your policy to be sure.
I wouldn’t worry about it just yet. Most claims, however, should be paid in 30 days. The fact that it’s been longer means the insurance company is balking.
Insurance companies, by and large, were scraped from Satan’s colon and will delay payment as long as possible. Especially large claims like yours. They’ll ask for medical records from the hospital, your doctor, your mailman, his doctor, and whoever else they think they need. However, if they did pre-cert the surgery, they really shouldn’t need medical records and if the hospital’s billing department is worth their salt, they won’t give in and should demand the insurance company pay the claim. There are laws about timely payment of claims and the hospital should not be afraid to pursue them. We do it all the time.
Sure, it’s going to cost a shit-ton of money, and dealing with the bills and paperwork will be nothing short of a grand mal migraine, but at least you’ll be a really really cool guy after it’s done. Popular. Together. Very with it. You know … hip.
:eek: It’s posts like this that make me thankful for medicare! I might have to wait a year or two to get a new hip, but I won’t have to sell my house to pay for it!
Get an itemized bill from the hospital beckwall. Then question stuff. They hate that. It’s amazing how much stuff is included, sometimes stuff that didn’t even happen. Plus, stay on the insurance company’s case about paying. You just have to do that. I second the idea of getting a receipt for any correspondence with the hospital or insurance company.
Request a chart audit. Someone, usually a RN, will go over the bill with a fine-tooth comb and per their hands on the documentation to back up the bill.
Since it’s been this long, call the insurance company on a regular basis. If they are just bullshitting around because of the amount, call them EVERY DAY. You’re paying the premiums, make them earn it. Don’t take no for an answer. Be sure to get the name of the person you talk to (including first initial of their last name) and record the time you called. Aggravate the hell out of them. That’s what we do and it works. Threaten to report them to the state’s insurance commissioner. Insurance companies that don’t follow the law can face stiff penalties. In Georgia, they can be fined up to 20% of TOTAL charges.
My last company makes hips and knees. Neat stuff, I forgot what the wholesale price is, but it’s several orders of magnitude under $47,000.
As an example, we made titanium bone screws too. A friend of mine has a few in his ankle. His insurance company was charged $150 each. We the manufacturer sold them for $9.00
I saw a TV show last night about a Three Million Dollar Baby - girl was born without a functional nose, eyes, mouth or ears and everything’s in the wrong place. $3mil later, she’s got two eyes and can almost breathe.
Medical biller here, radiology clinic. If the hospital does send you a bill for this amount, they may (and most likely will) have some system whereby you can make small payments to them just to keep the bean-counters happy to give you additional time to pursue your insurance company.
I’m not sure about your insurance, but my HMO insurance doesn’t cover durable medical goods (e.g., wheelchairs, walkers, crutches, et al) and may not cover something like an artificial limb or joint. You might check your policy just in case.
Doesn’t surprise me at all. The total for my leg surgery, physical therapy, etc. was around $100k at negotiated HMO rates, and I didn’t even have any artificial joints - just the plate, screws, and hybrid external fixator (though there were multiple surgeries, only the first should have been even remotely as complex as a hip replacement). Haven’t looked at any of the billing in quite some time, but for a while in the beginning the hospital was billing an insurance company I hadn’t had in 2 years, even though I gave them current insurance info on admission, which would explain why they weren’t getting paid. There were so many different invoices from so many different places that I’m sure there were duplicates and triplicates.
Took about 2 years for all the billing to sort itself out, but as everything was precertified by my HMO, I had only a couple of modest co-pays to deal with.
I saw a TV show on some orthopedic procedure or another, and it was startling to see them going at it with a DeWalt drill. That bright yellow really stands out against surgical blue.
But for the price, they should give you the drill as a souvenir.
