Breast Reduction; Normal For Such a Huge Mark Up?

my surgeon tells me he will submit a pre-auth & if its approved I'm all set. (knowing this was very unlikely, not surprised if wasnt approved) so my out of pocket quote for his surgical fee was $6500. I have some knowledge of the system Payers use with rate structures for In/Out of Network providers for different CPT's but a quick dig around this CPT seems to be 800-$1800 on average. Is it normal for such a huge mark up? I understand most of his clients are rich women, but 2-3x markup is crazy?

Tags:

costs normal

Comment on this

1 Doctor Answer | Asked by BillyIdle

Doctor Answers (1)
Community Comments (0)

Surgeon's Fee for Breast Reduction?

Thank you for the question. What you have been quoted as a surgical fee for breast reduction surgery is not “out of the ballpark” for most well experienced board certified plastic surgeons. The fees will vary from one part of the country to another. I think the discrepancy you note is not because the surgeons “markup” is “huge” but that the amount paid by insurance companies is inappropriately small ( given the... more