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Fri Apr 29, 2016, 12:02 PM

 

$150,000 for a double knee replacement

My wife recently had bilateral knee surgery. The total bill to the insurance company from hospitals, therapists and doctors was $150,000. $120,000 of that was the hospital. Other than two extra days (for a total of four) in the hospital, it was routine.

$30,000 per day.

The main problem with health care in this country isn't medical insurance, it is hospitals and doctors.

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Reply $150,000 for a double knee replacement (Original post)
lumberjack_jeff Apr 2016 OP
Post removed Apr 2016 #1
lumberjack_jeff Apr 2016 #4
Downwinder Apr 2016 #20
yourpaljoey Apr 2016 #5
scscholar Apr 2016 #2
Old Codger Apr 2016 #17
LibDemAlways Apr 2016 #3
Hoyt Apr 2016 #6
lumberjack_jeff Apr 2016 #7
Hoyt Apr 2016 #19
Gormy Cuss Apr 2016 #8
taught_me_patience Apr 2016 #9
Glassunion Apr 2016 #10
lumberjack_jeff Apr 2016 #11
Glassunion Apr 2016 #14
Wellstone ruled Apr 2016 #12
lumberjack_jeff Apr 2016 #13
Wellstone ruled Apr 2016 #18
BeanCounting Apr 2016 #15
Hortensis Apr 2016 #16

Response to lumberjack_jeff (Original post)


Response to Post removed (Reply #1)

Fri Apr 29, 2016, 12:08 PM

4. The main problem I see with insurance companies isn't their profit margin...

 

... but the fact that they're relatively powerless to establish fair prices.

That's the reason that single payer is the solution, they are empowered to say, "No. If you want to sell medical services, you can't charge $30,000 for 24 hours in a bed."

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Response to lumberjack_jeff (Reply #4)

Fri Apr 29, 2016, 01:48 PM

20. When profit is based on a percentage of expenses

there is no incentive to lower expenses.

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Response to Post removed (Reply #1)

Fri Apr 29, 2016, 12:12 PM

5. Hill will fix us but good

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Response to lumberjack_jeff (Original post)

Fri Apr 29, 2016, 12:07 PM

2. Sad to see how greedy those doctors are

 

My great-nephew recently flew to the Philippines for a knee replacement. I think he spent $6k including air. It's sad you have to go to the othe side of the entire world just to find people that aren't so greedy.

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Response to scscholar (Reply #2)

Fri Apr 29, 2016, 01:01 PM

17. Surgery bill

 

less than one day,in and out same day, Dr. bill under 500, hospital bill over 20K...It isn't the Dr's.

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Response to lumberjack_jeff (Original post)

Fri Apr 29, 2016, 12:08 PM

3. Think about all of the people in pain who can't afford the

surgery because they can't afford insurance or they can't afford the co-pays and deductibles. Yes, hospitals and doctors charge outrageous sums, but the greedy insurance companies are a huge part of the problem. We need single payer universal coverage for all.

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Response to lumberjack_jeff (Original post)

Fri Apr 29, 2016, 12:15 PM

6. Since she is insured, the doc's and hospital together will probably get $20 - $30,000 or so, rest

 

will be written off. Still a lot. It's just a game providers play. Docs and hospitals charge a lot more than they ever expect to get. Heck, some doctors charge Medicare 10 to 20 times what they end up accepting from Medicare.

Hope she is recuperating well, and you the nurse.

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Response to Hoyt (Reply #6)

Fri Apr 29, 2016, 12:18 PM

7. She's doing great, thank you.

 

It isn't a game to the uninsured person who would pay the full price in bankruptcy court, and single payer would end that game immediately.

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Response to lumberjack_jeff (Reply #7)

Fri Apr 29, 2016, 01:48 PM

19. That's a real flaw in the system, although if those patients get an attorney the hospital/doc will

 

usually settle for around Medicare rates. But you are right, some groups will at least put pressure on the poor uninsured person for the full amount, which is ludicrous because they obviously don't have it.

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Response to Hoyt (Reply #6)

Fri Apr 29, 2016, 12:19 PM

8. ^^This^^

It's a feature of our nutty system.

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Response to lumberjack_jeff (Original post)

Fri Apr 29, 2016, 12:30 PM

9. They'll probably collect about 50% of that bill

 

The real problem is that the hospital has to charge 120k to cover free-loaders who require services but are uninsured.

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Response to lumberjack_jeff (Original post)

Fri Apr 29, 2016, 12:31 PM

10. Actaully, it's $75,000 per knee, or only $15,000 per knee per day.

Doesn't look so bad now does it?

I recently went to the hospital... Charged $3,000 for two x-rays, and blood work. The bed in the ER was comfy as shit by the way.

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Response to Glassunion (Reply #10)

Fri Apr 29, 2016, 12:34 PM

11. If each knee occupied a different hospital room, you might have had a point. n/t

 

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Response to lumberjack_jeff (Reply #11)

Fri Apr 29, 2016, 12:37 PM

14. lol

It's obscene what hospitals charge.

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Response to lumberjack_jeff (Original post)

Fri Apr 29, 2016, 12:34 PM

12. Wow,Inflation has really hit the knee replacement costs.

 

Had a knee replaced twelve years ago this month. Total bill was 24k with therapy and three days Hospital stay. Comp paid the bill,but still 75k per knee,geez. BTW,my bill was 8k for the Doc,4k for the appliance,and the rest was Hospital and P.T..

Remember,Insurance Companies since 1945 are allowed to collude on pricing without any over sight.

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Response to Wellstone ruled (Reply #12)

Fri Apr 29, 2016, 12:37 PM

13. Now that I think about it, I haven't seen a bill for the knees themselves.

 

It will probably wind up being much more than $150k.

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Response to lumberjack_jeff (Reply #13)

Fri Apr 29, 2016, 01:31 PM

18. And Paul Ryan wants to whack

 

people with preexisting conditions. Most Joint replacement falls under Medicaid and Medicare.

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Response to lumberjack_jeff (Original post)

Fri Apr 29, 2016, 12:43 PM

15. Knee replacement costs

That price doesn't seem too off the mark. I just had two replacements in Dec and each were $65k and on each I went home same day as surgery, no complications. Hence this price does not cover the PT you get while in hospital.

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Response to lumberjack_jeff (Original post)

Fri Apr 29, 2016, 12:47 PM

16. Don't read if you have high blood pressure.

This is from an excellent article in the NY Times. http://www.nytimes.com/2013/08/04/health/for-medical-tourists-simple-math.html?pagewanted=all

The man profiled here spent $13K in Belgium for a hip replacement that would have cost over $100K here. (Note that thanks to Obamacare, his insurer could not now refuse to pay on even a genuine preexisting condition.)

So why are implant list prices so high, and rising by more than 5 percent a year? In the United States, nearly all hip and knee implants — sterilized pieces of tooled metal, plastic or ceramics — are made by five companies, which some economists describe as a cartel. Manufacturers tweak old models and patent the changes as new products, with ever-bigger price tags.

Generic or foreign-made joint implants have been kept out of the United States by trade policy, patents and an expensive Food and Drug Administration approval process that deters start-ups from entering the market. The “companies defend this turf ferociously,” said Dr. Peter M. Cram, a physician at the University of Iowa medical school who studies the costs of health care.

Though the five companies make similar models, each cultivates intense brand loyalty through financial ties to surgeons and the use of a different tool kit and operating system for the installation of its products; orthopedists typically stay with the system they learned on. The thousands of hospitals and clinics that purchase implants try to bargain for deep discounts from manufacturers, but they have limited leverage since each buys a relatively small quantity from any one company.

In addition, device makers typically require doctors’ groups and hospitals to sign nondisclosure agreements about prices, which means institutions do not know what their competitors are paying. This secrecy erodes bargaining power and has allowed a small industry of profit-taking middlemen to flourish: joint implant purchasing consultants, implant billing companies, joint brokers. There are as many as 13 layers of vendors between the physician and the patient for a hip replacement, according to Kate Willhite, a former executive director of the Manitowoc Surgery Center in Wisconsin.

Hospitals and orthopedic clinics typically pay $4,500 to $7,500 for an artificial hip, according to MD Buyline and Orthopedic Network News, which track device pricing. But those numbers balloon with the cost of installation equipment and all the intermediaries’ fees, including an often hefty hospital markup.

That is why the hip implant for Joe Catugno, a patient at the Hospital for Joint Diseases in New York, accounted for nearly $37,000 of his approximately $100,000 hospital bill; Cigna, his insurer, paid close to $70,000 of the charges. At Mills-Peninsula Health Services in San Mateo, Calif., Susan Foley’s artificial knee, which costs about the same as a hip joint, was billed at $26,000 in a total hospital tally of $112,317. The components of Sonja Nelson’s hip at Sacred Heart Hospital in Pensacola, Fla., accounted for $30,581 of her $50,935 hospital bill. Insurers negotiate discounts on those charges, and patients have limited responsibility for the differences.

The basic design of artificial joints has not changed for decades. But increased volume — about one million knee and hip replacements are performed in the United States annually — and competition have not lowered prices, as would typically happen with products like clothes or cars. “There are a bunch of implants that are reasonably similar,” said James C. Robinson, a health economist at the University of California, Berkeley. “That should be great for the consumer, but it isn’t.”


This is all changing under Obama, of course, and will continue to change if we elect another Democratic president, but way too slowly for individuals who can't come up with a ready $400 much less afford 20-30% coinsurance on a $150K operation.

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