this post was submitted on 17 Oct 2024
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I'm in the middle of trying to get a fairly expensive surgery.
If I had insurance, I would need to pay about $15,000 (between premiums, copays, annual deductible, coinsurance, and out of pocket maximums) with the only insurance available to me through my workplace before anything would be covered. So it's not really worthwhile, right? Well, the surgery I need--around here--gets quotes of as much as $89,000. The most recent quote that I have is around $18,000. Keep in mind that the surgery takes about an hour, is a surgeon, one OR nurse assisting, and an anesthesiologist. The fee for the surgeon and nurse is about $5000, and the facility takes about $10,000. In the case of surgery in a hospital--rather than an ambulatory surgical center (ACS0---it's even worse. With the same surgeon and OR nurse at an ACS, I had a quote of $16,300; at a hospital the quote was $49,000. The surgeon and nurse get the same fee regardless, which means that the hospital charged >$30,000.
...And good fucking luck getting a lot of places to give you prices at all, even though DHHS has mandated pricing transparency. Even if you know exactly what CPT billing codes are going to be used, it can be days of back and forth before you can get a price. If you need shit fixed NOW, you're just going to be stuck with whatever they charge.