• Dean Cranney

Cost and Value...

So I thought I'd illustrate a little more about value propositions in health care by telling another story of my experience this time with a surgical procedure.

A few years ago I had a knee arthroscopy done (i.e. a knee scope). My surgeon was wonderful as were all of the staff who checked me in, took care of me in the waiting area and in the recovery room. I left the surgery center with little to no pain and recovered quickly thereafter. I knew my surgeon professionally as well as personally. I had the surgery done at a facility owned by my then employer.

The surgery was performed around September and I ended up getting my first 'explanation of benefits' from my insurance company two months later. They listed the 'price' for the surgeon and the hospital fees at around $35,000. Luckily with my insurance contracted rate the price was only $18,000. They also stated that they were waiting on the hospital and surgeons office to send over the notes from the surgery to justify the procedure. As they hadn't received them yet, it was listed that I would be liable for the entire amount.

I contacted the hospital system and they assured me that they would be sending over the documentation needed for the insurance company.

This back and forth conversation with the insurance company, the hospital and myself went on through April of the next year. I was then contacted by the billing department of the hospital in question and told that I needed to pay my portion of the bill still. They couldn't tell me what 'my portion' would be because they still hadn't received any payment from the insurance company. Mind you this is the same insurance that they provided to me as an employee. They asked if I would set up a payment plan but I declined until the billing documentation had been given to the insurance company and they had paid their portion. mind you the insurance company still hadn't yet received the documentation requested the year prior.

By the end of April, the insurance company finally received the paperwork and then paid their portion of the bill. I then called the billing department at the hospital to arrange for my payment and they graciously applied my employer's "hometown discount" telling me that my portion of the bill was now zero. It was about 1 month later that a bill showed back up on my account and I was called and threatened with being sent to collections if I didn't pay. With the amount now clearly listed I paid the $1200 or so dollars that was left on the account and it was closed.


So after everything was said and done, the total price for the knee surgery was $18,000 for the hospital services + $3000 for the surgeon and another $3000 for anesthesia = $24,000.

So I'm thinking, I wonder with the real cost and charges for this surgery could have been. I referenced the Oklahoma Surgery Center for their online pricing quotes and find that the all inclusive price for that particular surgery is $3750 for a single knee scope. This includes the surgeon, anesthesia, medications given during the surgery and any routine follow up and preoperative visits. So if I had a cooperative insurance company, I could have taken their $22,000 that they paid toward the surgery and paid for plane tickets, a 4 star hotel, the surgery, and probably even a dinner and a show and saved them $17,000.

Wow! And there's no surprise billing, no collections threat, and the whole process is open and transparent.

So why is our health care system arranged in this manner?

Well THAT is a subject for a future entry. . .

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