I Haven't Been Able to Find Anyone to Give Me an Answer. Is the $41,580 Charge for Alloderm Graft 16X in the Ballpark?

I was also charged $14,483 for expander tissue. My insurance co. considers these part of hospital misc and my plan caps hosp misc at $10,000/yr (hosp misc came to $95,151.00 of my bill). The hosp wants me to pay $42,000 after my plan paid their part. I'm retired and have no idea how I'm ever going to pay that back. I honestly think the charges are wrong but I can't find anyone to tell me. I've been unable to get anyone to answer my call at the hosp.

Doctor Answers 4

Real costs of expanders and alloderm

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Welcome to today's world of hospital bills. Actually, the hospital pays for one sheet of Alloderm anywhere from $500 to $6000, dpending on the size. There are bigger sizes and prices, but this should include even the biggest size ever used for breast reconstruction. Most use the 6x12 cm size which is around 3k. The tissue expanders are around $1000 - $2000. The hospital usually submits a HCPCS form to the insurance which bills for these special items, and gets reimbursed extra for them - they aren't miscellaneous (like an oxygen cannula). There is no way you could have had the surgery without these critical items - I wonder what they do for joint replacement surgery? Assume that the new knee is a miscellaneous item? Ridiculous! Good luck - be strong and make lots of phone calls and you can usually make progress!!!

Beverly Hills Plastic Surgeon
4.7 out of 5 stars 16 reviews

Cost of Alloderm

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The  largest piece of Alloderm is 20 by 16 and a rough estimate cost is generally $13,000. Remember each hospital institution has the right to up charge on any product. Also in many circumstances of  reconstructive surgery more than one piece of Alloderm 

James Fernau, MD, FACS
Pittsburgh Plastic Surgeon
4.9 out of 5 stars 86 reviews

Alloderm Cost

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Alloderm can be expensive but this seems really high. Typically an 8x16 size is used for breast reconstruction and can cost the hospital anywhere from $3,000-$6,000. I would definitely contact the hospital and insurance carrier to double check the bill. if that proves to be unsuccessful, I would contact LifeCell directly as they will be able to tell you what they charge the hospital for Alloderm. Usually when patients get involved, hospitals and your insurance carrier will start to listen! Good luck! 

Cost For Alloderm

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There is so much to say about medical costs that it certainly can not fit in here.  The cost of the alloderm varies depending on size but $3k is about right.  What makes this difficult is that first the hospital makes up a bill.  It is total fantasy with numbers pulled out of the air.  Then the hospital submits the bill to insurance.  The insurance company has what they call an 'allowed amount'.  Basically that is what the insurance company is willing to pay.

Now - if you have to pay a percentage it is NOT from the fantasy bill, but from the allowed amount.  So the real cost is the allowed amount, not the fantasy bill.

But... where it gets tough is if the insurance company doesn't pay for part of your charges, you are stuck with the fantasy bill.  One suggestion might be to get the insurance company to tell you what the allowed amount would be on the miscellaneous items if your plan covered them.  You can then go back to the hospital and see if they will reduce their price to the real amount (the insurance company allowed amount) and not the fantasy bill.  Most likely the allowed amount is within the $10k misc amount.  Sorry if this is confusing - and we have to deal with it every day.  Good luck to you!

Al Rosenthal, MD
Lawrenceville Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.