I had a breast reduction about a month ago. Very straight forward and from what surgeon said the surgery went well. Mine was covered by insurance due to problems I was having because of my large breast. However, I was blown away when my bill arrived and I found out that i was charged $54,000.00 for an outpatient surgery! Again I have insurance, but my max out of pocket is high and I was not expecting it to be exhausted from this procedure!! How can this be justified and not be price gouging?!?
Answer: Expensive breast reduction even with 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.
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Answer: Expensive breast reduction even with 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.
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October 20, 2015
Answer: The vagaries of insurance billing for breast reduction are quite bizarre. 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.
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October 20, 2015
Answer: The vagaries of insurance billing for breast reduction are quite bizarre. 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.
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October 18, 2015
Answer: High surgery cost for breast reduction 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
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October 18, 2015
Answer: High surgery cost for breast reduction 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
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October 19, 2015
Answer: Outrageous hospital bill 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
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October 19, 2015
Answer: Outrageous hospital bill 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
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October 17, 2015
Answer: Concerned about Bill 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.
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October 17, 2015
Answer: Concerned about Bill 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.
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