How can surgery cost so much more just because my breast reduction was covered by insurance?

Although this number is huge, try not to panic. I would recommend first calling the hospital to see if they have billed your insurance company yet. Often the billing department is disorganized, and if a claim is delayed or initially rejected by the insurance company (which happens very, very frequently) the patient will receive an incorrect bill. You may also be able to check on your insurance company's website to see if an EOB (explanation of benefits) exists for this claim. The EOB will explain how much the insurance company allows for a claim- i.e. how much they will pay- as well as what portion you owe. Usually the insurance company only allows a very small fraction of the actual fee the hospital or doctor charges. For a breast reduction, the average charge submitted by a surgeon is around $10,000 ($5,000 per breast), but the actual amount allowed by insurance is only $1,000-$2,000. The process is similar with the hospital and anesthesia portions of the bill.

Clearly the bill is ridiculous for uncomplicated outpatient surgery. However, this is the process that is commonly undertaken when insurance enters into the payment process. It is highlyUnlikelythat the hospital and the surgeon will come even close to collecting that kind of money.

As already stated, you are seeing the high costs often associated with doing surgery at a hospital. For future reference you can often talk with a financial advisor at the hospital to get an estimate of the expected bill for a planned surgery. I would also recommend getting an itemized bill for this particular surgery. The surgeon's fee is a mere fraction of that bill. My guess is that the surgeons fee is somewhere around $3000 give or take. Good luck and take care,Dr. Howell

This is the true problem that exist in medicine.  Back when there were just two parties involved in medical decisions and medical charges ( the doctor and the patient) hospitals would have not had the insane belief that a 54,000 bill for a 3 hr surgery and outpatient care or short stay hospital would be appropriate. Since we all are in the trust of the bigger bureaucracy , it should all be better (haha ) .  Charges are limited for doctors.  We are bound by the CPT code book and by rvu system to try to recapture fees for work that we do. Hospitals on the other hand are run by businessmen. Similar to the ones that bought the drug company recently and increased the drug prices by 5000 percent.  They charge what they want and rely on negotiations to get bigger fees .  When The doctor controls charges for everything from free market competition, you get a bill for about 7500 for everything (surgeon fee, surgery center fee and anesthesiologist ) .  When businessmen have the same thing in their hands they ask for 54,000 just for their portion in hopes that insurance will pay 10-15 thousand.  Also don't be surprised if you get a 3000 bill from your surgeon and a 3000 bill from your anesthesiologist to boot

What you may be viewing is what the hospital charges.  This is not what you owe (typically) or what the insurance company will pay.  There are set fees that the insurance will pay for certain procedures.  Please take that info you recieved to your plastic surgeon's office manager for explanation.

I agree with some of the other physicians' statements but I also agree with you that these charges seem to be extremely high for an outpatient surgery.  You should ask for an itemized summary of charges so that you can ensure that your insurance company is being billed accurately.

This is more than likely the hospital fees.  Best to ask the facility what the charges are for and what you might owe.

You are learning a little bit about the game the insurance companies and hospitals play.  Sticker shock when you look at a hospital bill is not unusual at all. You will be responsible for your deductible and that is it.  Once your deductible is met then you have no more financial responsibility.  The problem is that if you chose an insurance policy that has a high deductible you are responsible for that amount.  Prior to your surgery you should have spoken with someone at your plastic surgeons office so you understand what your responsibilities are.

I am very pleased to see someone asking questions about costs of health care! Short answer to your question, yes, that cost is ridiculous! The fact is, the amount insurance bills and the amount that is ultimately reimbursed are not the same. That number you shared is not necessarily a "real" number. The amount the hospitals bill versus the amount it actually costs them are not the same.  The amount insurance bills versus the amount it actually receives are not the same. What is real and what is mark up is very very unclear in nearly all cases. For complex reasons the costs of medical care have been unknown by patients and, in many cases, by physicians, and they do not reflect reality due to price shifting. I am not sure we are in a position to use "market place forces" or "consumer choice" in health care reform when these things are so discrepant.  One good move towards increased transparency in health care are mandates made by Obamacare to monitor and make public costs per provider for the various procedures they perform.  Unless you had extraordinary complications with your surgery, your bill reflects a number that is about 4 times what it would have cost if you had a self-pay breast reduction! Also interesting for you to know, the amount your surgeon may have been reimbursed is probably 4 times less through insurance than what you would have paid as a "cosmetic" breast reduction patient. Now that patients are paying so much through deductibles, and now that costs are transparent (if you take the extreme trouble to investigate) patients can start to have a voice in consumer value of medical care!!! I hope your surgery went well and I hope you follow through on your curiosity about your bill!  Best wishes!!!