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1036535 tn?1278502599

LP cost

I think the amount billed to my insurance is ridiculous.  Can anyone tell me how much the hospital portion of the LP as an outpatient normally is (I will keep in mind prices obviously vary by region, but I thought I was in a lower cost area)? I'm going to call and get an itemized bill, but while waiting I was curious...
35 Responses
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667078 tn?1316000935
Mine was $14,000 in 2009.
Helpful - 0
1036535 tn?1278502599
Thanks for your response.  

My insurance was billed for just over $22,000.  That seemed like an awful lot just for the collection kit, a little lidocaine, and letting me lie in their bed for hours. Yes, my doc is old school and made me stay flat for 8 hours. And I still got a headache and needed a blood patch!

The hospital then billed my insurance for $41,000, which included the previous charges. That does not include the subsequent charges for the blood patch.
Helpful - 0
572651 tn?1530999357
I am going to pull my records and tell you - I know there is no way my LP cost that much.  It was done in the doctor's office and not a hospital, and that was not quite two years ago.

Wow. That $$$ amount is crazy.  You can get a hip replacement or two or three heart bypasses for that price.  something must be wrong with this figure.  I would check it out.
-Lu
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667078 tn?1316000935
Mine was done in an OR and I was completely sedated. My Gallbladdre surget with a night's stay was not much more.

Alex
Helpful - 0
1045086 tn?1332126422
My LP was done in the radiology department.  I was flat on a gurney for one hour afterwards.  The hospital billed for less than $1000 for the procedure.

Mary
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1036535 tn?1278502599
Looking at the EOB from insurance they repeatedly charged me for something that cost $89.72.  The only thing I got more several times was Pepsi, and I know an 8 oz. can doesn't cost that much ;) I can't believe the stupid insurance company paid this right away, but haven't paid other, more legitimate things without a fight!
Helpful - 0
1253197 tn?1331209110
$41000 ************************ I am speechless. I think we have it a lot easier in England!

Cheers, Sarah
Helpful - 0
1045086 tn?1332126422
All health care systems are complicated Sarah.  I believe they are designed that way originally to serve a purpose and then evolve into an even more bizarre form.  We merely get used to working within the system we are used to.  I'm sure they change the rules often for the same reason the credit card companies do.  Consumers who can't keep up with the changes, pay and/or lose.

Rarely will a provider get paid the total amount they bill.  Insurance companies contract with them to pay set amounts for specific procedures.  I wouldn't be surprised if this bill gets reviewed by insurance company employees whose sole purpose is to challenge charges.  Still, MW is right to get the itemized bill and challenge it herself because any payments made can go against the yearly or lifetime maximum on a policy (and with MS treatment it is possible to reach those maximums).

Mary
Helpful - 0
147426 tn?1317265632
There is a good reason that cost of medicine is so high.  That is literally robbery!  I would get the itemized bill and complain about this to the Insurance Commission for your state.

I had two surgeries back in the early nineties at different hospitals in different states.  Each time they billed TWICE the number of minutes for the OR as I spent there.  In one case a 3 and 1/2 hour surgery was billed for 425 minutes.  Another was a ninety minute surgery was billed at 180 minutes.  

This is insurance fraud, some of it "legal" and some just out and out fraud.  We all need to point out this kind of excess where we find it.

Quix
Helpful - 0
Avatar universal
An LP done PRIVATELY here is $480, but medicare pays 400 of that, so 80. If done as a patient in a  public hospital there is no cost.

14,000??????22,000????

Hooray for universal health care is all I can say!


I guess the diff is you poor people pay into a 'for profit' system, where the profit of the insurance company is more important than the health of the people ..........god almighty, what a system!
Helpful - 0
572651 tn?1530999357
As promised, I pulled my bills -
My LP was in Sept. 08 and done in the doctor's office, as part of the OSU Hospital system.  No OR

Dr. billed $425 to my insurance and got paid $212.17 from insurance and $20 from me.

OSU billed $557 to my insurance and got paid $238.40.  I did not have to pay anything because I had already met my deductible for the year and this was not a co-pay.

So, my total LP cost less than $500.  

That sounds a lot more reasonable.  Even if prices have substantially increased, and they have.  And even if this was done in a hospital, there is no way this bill should be in the thousands of dollars.  My husband's 4 day hospitalization last year with  two cardiac catherizations and one stent placement was significantly less than what your insurance has been billed.

Good luck in sorting it out.

be well, Lulu
Helpful - 0
1036535 tn?1278502599
This is why I'm happy the reform passed.  No I do not think it is the best thing, but at least we are going SOMEWHERE! But I won't get started on a political (and ethical) soapbox :)

I had laparoscopic surgery w/ DaVinci robot (very high tech) with an unplanned overnight stay that only cost about $40,000.  Insurance still hasn't paid (done in Dec.).

I hope it's an honest input error.  I work at a (different) hospital, and I know those things happen. However, I am a little suspicious that this hospital might be trying to get more money since most of their patients are Medicaid or uninsured ,which translates to very little revenue of course.  I am blessed to have coverage through 2 private insurances.

Anxious to see bill when it comes next week.
Helpful - 0
1045086 tn?1332126422
You could also notify the compliance officer at the hospital (the operator should be able to connect you).  HIPPAA requires hospitals to have one and they must investigate all complaints to be sure they are billing fairly and according to established rules and guidelines.  This is surely an error.

Mary
Helpful - 0
572651 tn?1530999357
One other point that someone made up there - our system is very confusing because of that negotiated payment amount that insurance companies set with the providers.

Basically, it is a one-sided agreement.  The insurance company says XX procedure is going to be worth $$ amount.  No matter what is billed for XX, the insurance only pays $$.

But sometimes, the insurance company will say, they will pay 1/3 of the XX cost.  So the provider finds a way of inflating the XX cost so the $$ increases.   The provider gets more $$ that way.

Now, for the patient who does not have insurance,  XX is usually the $$ they must pay to the provider, unless they negotiate with the provider (works with hospitals if you get lucky, but rarely with the individual doctors).  Sometimes you can get a discounted rate because you don't have insurance and they will factor in a small $ discount.

It is a crazy system - I hope something in this makes sense.  
-L

Helpful - 0
1260255 tn?1288654564
I just looked at the hospital bills. They submitted two separate claims that totaled $9,377. The first claim was for $5,615 and the hospital was received over $4,700 between insurance and my co-pay. The other claim of $3,762 was denied by the insurance company on the basis that the maximum amount had been paid for this procedure.

The procedure took less than 15 minutes (done on a tilt table) and I spent an hour on a gurney after that.

My son's tonsillectomy in January cost less than this, including charges from the surgeon, anesthesiologist and the hospital.

MRI's with contrast are billed at $4,920, but the negotiated rate is only $600. Doesn't make sense given the cost of equipment and the length of time the technicians spend with the patient.

Medical costs are definitely out of whack.
Helpful - 0
1307298 tn?1305946851
Wow.  I don't remember how much mine were, but 14k and 22k seem way out of wack.  I spent 5 days in the hospital with double vision and had an LP, an MRI and lots of blood tests and the total bill was only 40k.  Something is totally wrong with the system to have that much variability.  
Helpful - 0
645800 tn?1466860955
When I had my triple bypass surgery the total bill was only $63,000 which included all of the different doctor bills, 3 day in intensive care, and 2 days in the cardiac care unit. This was in 2006 and I doubt if costs have gone up that much since then.

Dennis
Helpful - 0
Avatar universal
Jean ........the bill was "only 40k"......and sailorsong ......."only 63,000"..............lawkes a lordy, I am more happy by the moment that I am NOT an American!

Why you're not all demanding full universal health care for everyone mystifies me!
Helpful - 0
667078 tn?1316000935
Hey my part of my recent gallbladder is over $3000 and I am still getting bills. We pay over 10 percent of our income to my medical with out hospitals and ER. Our income has been cut in half since 2001 and I do not qualify for disability. I will not get assistance from the government for twenty years. Ironically I got MS as a child but the documentation, my navy health record has was burned in a house fire. I do not worry what is fair,

Alex
Helpful - 0
572651 tn?1530999357
By now I'm sure all of you with universal health care in the UK, AUS, and elsewhere are giving quiet thanks.  The weird thing about this is even though we are kicking around these gigantic dollar figures, the reality is the providers don't get that amount.   So that "only 63,000 turns into maybe $18,000" (just a guess!) and then you factor in what part of that is our share to pay.  

The patient's share is figured according to the insurance plan you are on.  There is almost always a maximum amount a pateint will have to pay out of pocket, if you have reasonable insurance.  The biggest problem is when you don't have insurance, or a lousy one.  From all of our examples you can see how that can quickly cause financial insolvency if you are not among the fortunate to have good insurance and have a catastropic illness like MS or cancer.

You usually get good insurance by paying quite a bit in premiums.  The higher your costs up front  for the insurance, the less out of pocket you would usually be paying in the end if you use the medical services.  

You can see that it is a  crazy environment here when this procedure, done in different settings and different ways can range from $500 to $40,000.  Yes, it's nuts!  

This makes my head spin. Lu
Helpful - 0
645800 tn?1466860955
Lulu,

   Your guess was pretty close except the $18,000 was how much less Medicare paid versus the total bill. Out of the $63K I had a copay of about $2000 total for doctors and hospital bills and it took me 3 years to pay that off.

  When I was using Medicare for my health care typically for a doctor visit was about $125 and Medicare would pay the doctor $80 and I would end up paying $16 of that.

Unfortunately before the Medicare RX plan came into effect I had to pay full price for all of my medications. As a result I went close to $50,000 in debt in order to get my medications over the first 15 years of being disabled.This was mostly due to having a $1300 per month for medications for several years. Right now through the VA my medicine costs me about $200 per month.

I think the most outrageous thing I found in the way of health care was when I lived in Connecticut. Just prior to my daughter needing a tonsillectomy the state passed a new law that allowed hospitals to charge more for a day surgery if the patient ended up having to spend the night in the hospital that was not based on actual cost but the normal costs for intensive care. My daughter ended up spending the night so there was an extra $8000 on the bill which increased my copay significantly. The only reason they kept my daughter was because she hadn't come out of the Anesthesia enough by 5PM.

Dennis
  

    

Helpful - 0
1260255 tn?1288654564
LuLu makes a good point in explaining some of the intricacies of health insurance here in the US:

"One other point that someone made up there - our system is very confusing because of that negotiated payment amount that insurance companies set with the providers."

"Basically, it is a one-sided agreement.  The insurance company says XX procedure is going to be worth $$ amount.  No matter what is billed for XX, the insurance only pays $$."

I personally find it shocking some of the negotiated rates for doctor's visits and don't know how they can stay in practice. I'm not sure how often these rates are negotiated, but here are some of the doctor visit charges and amounts actually received, including the co-pay:

Neurologist            Charge $264             Received $119
ENT                                  $ 95                            $ 73
Hematologist                     $155                           $ 80
Internist                             $155                          $125
Family Therapist                 $100                          $ 60

My Internist/PCP must have recently negotiated her rate, because the rate before was much lower. It's sad to see a family therapist getting close to the same amount as medical doctors with advanced degrees and practices that involve significant staffing requirements and equipment.

When I was growing up, we used to think that doctors were rich. When you look at the cost of education on top of the cost of running a business against what they are reimbursed, that is no longer the case.
Helpful - 0
1312898 tn?1314568133
These amounts are ludicrous.  A physician is certainly worth being highly paid for their expertise, education and training.  And let's face it, it's  huge responsibility.  That being said, I do expect a doctor to 'pay attention' to us when in their care.  Many of us have been brushed aside------yet they get paid.  I don't know about you, but I don't get paid if I don't do my job.

I do think that some of these rates are ridiculous.  One thing that hasn't been covered is the increased cost of malpractice insurance.  This costs probably 100k a year.  Patients sue all the time; some for legitimate reasons, many are not legitimate.  All of the doctors, hospitals and/or clinics have to pay individually.  We are a litigious country.  

Then doctors often practice 'Defensive Medicine" due to the high rise of malpractice suits.  They will order more tests then necessary to keep their malpractice rates lower.  Again, because of those who sue.  

The family therapist rates are ridiculous.  His/Her insurance is nothing compared to the medical community.

Doctors are already 'opting out' of Medicare because reimbursements have actually gone down.

Our health system is a mess.  

Why do people say we have the best healthcare in the world,   I just don't get it.

Red
Helpful - 0
Avatar universal
I cannot believe someone had a charge of $22,000 for a lumbar puncture. That cannot be right.
I am in the UK so get all my treatment whatever it is, for free. If I had to guess at the cost of a lumbar puncture for private patients it would probably be no more than £1,000.
Helpful - 0
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