Question about costs

[Roger P]

Hello, and thanks for maintaining all this great information on your web site.

Both my wife and I are suffering from osteoarthritis to the point where daily life is dreadful -- meaning we pretty much are either in pain or we're dreading the return of pain. I am 54; my wife is 60. And I'm sure no one in this forum needs to hear any more about pain, so let me explain where we are and ask a question or two.  We have just started researching hip resurfacing, after a visit to a THR surgeon near our home in Virginia whose pronouncements about "you'll just have to trust me" and "I'll do whatever is best for you" caused us a couple of weeks of confusion and hopelessness.  (My wife teaches yoga and dance therapy and was heartbroken to hear of the reduced mobility associated with THR, especially as outlined by this surgeon.) Then a friend told put us in touch with a friend of hers, also an active, yoga-practicing 60-something woman of approximately the same height and weight of my wife, who had been to Belgium and had bilateral hip resurfacing with Dr. de Smet last year. And then we found this totally excellent web site and forum, and everything seems much more hopeful.

My question: I have insurance through work with Aetna, but our plan covers nothing overseas except emergency medical care. I'm just wondering how to figure out whether our share of an insured procedure (either 10 percent or 30 percent, depending on whether the doctor is "in" or "out" of Aetna's network) would cost more than the trip to Belgium -- and the one thing I just cannot find on this forum, for some reason, is some estimate of what hip resurfacing costs in the U.S. Is that something I should not discuss publicly here, or am I just having my usual problems with search engines? (Plus it's Memorial Day weekend and all the doctors' offices are closed till Tuesday.)

Thanks,
Roger

[Pat Walter]

Hi

Welcome to Hip Talk.

You can't find an estimate of what a hip resurfacing will cost because most hospitals won't or can't tell you.  It is like pulling teeth to find out.  I tried several years ago.  It is amazing to me that a hospital can't tell you the cost of a procedure - but as you will find, very few can.

I can tell you that Dr. Gross of SC will give you a cost.  It was $25,000 about 2 years ago.  You can find his email address on my doctors list.

Where do you live?  You might look for the most experienced surgeons in your area and ask their office staff.  Doctors can't tell you at all because they don't seem to know.

The range of costs I have seen over the years is anywhere from $30,000 to $80,000   No one seems to get charged the same.  You need to choose several doctors, then pound on the hospital until you can get a cost.

Going to Belgium now is probably well over $20,000 for one hip for the whole trip.  Everything has gone up because of the weak dollar.  It cost $18,000 two years ago for my hip resurfacing and the whole trip with my husband. 

Don't forget you can also go to Dr. Bose in India, one of the best in the world, for a total cost of $10,000 to $12,000 including first class air fare.  India is getting to be the best option financially any more due to our dropping dollar. 

I am sorry I can't help you further with costs.  I just know I was 61 several years ago, did not have health insurance and wanted someone really experienced to do me since I was female and had a loss of bone density. So I chose Dr. De Smet.  Even if I had Insurance, I would have chosen him.

Are you able to appeal your insurance companies ruling?  Many have done so, but I don't know about Aetna.

You can continue to discuss cost - but the only way to find out is to join the Yahoo Surface Hippy Group and read many old messages.  Many people will tell you what their surgeries cost.  That is where I came up with the $30,000 - $80,000  The costs are all over the place.  I was quoted about $30,000 for a MOM THR in Columbus OH 2 years ago. 

You will really have to chose several doctors and make some calls.  Many probably won't talk with you free.  That is the great part of the overseas doctors like De SMet and Bose - it is a free consultation.  Dr. Gross is free and I think Dr. Su in NY is free.  There are more US doctors will to give consultations via email with attached x-rays in a digital format as a .jpg   I have a section of how to convert digital x-rays on the website.

Keep in touch and let us know what you find out about the cost of surgery.  I am sure others will like the information too.

Enjoy the Holiday Weekend!

Pat

[rlm869]

i wanted to post a response to this because i asked this question months before my surgery and no one even responded with an estimate. i have not received my final bills yet, but i can tell you what my bills before insurance are.

my total hospital bill before insurance was $33,000
my total surgeon + assistant bill before insurance was $15,000

i have not received a bill from the anaesthesiologist yet. but by the time i get it i should have reached my out of pocket and it should be 100% covered.

from what i understand of your post you have not consulted with any other surgeons in the united states. there are many experienced surgeons here and i think it would cost you less to travel to one of them. from what i understand, aetna pays for resurfacing and they should pay for a surgeon out of state.

[xocy]

I am scheduled for bi-lat with Dr. Gross in late June and have been a frequent participant on this Board lately. I have some knowledge of health insurance.

Dr. Gross has an area on his web site, www.grossortho.com, that shows the plans in which he is a paritcipant. He also discusses his fees in detail. Keep in mind these things constantly change and I suggest you call his office for verification.
 
THERE IS NO WAY, I would go out of the US for this if I had insurance.  Keep in mind that if you choose to go "out of network" here in the US,  you will loose the benefit of the negotiated rate your insurance company has with the surgeon as well as the hospital and orther providers. If you do this my suggestion would be to get Aetna to give you a verification as to what they would allow for the provider fees. Remember, you will pay 30% of the allow rate,plus 100% of the excess over the allow amount. It still might not be too bad.

This may pale in comparison if your hospital is out of the network. Hospitals give giant discounts. Be sure to ask your provider if they will pay a network hospital as "in network" even if you are using an out of network doc. Check the anethsiologist as well (they are the most common claim problem). If the hospital is "out of network" and you choose to use them, they will usually negotiate in exchange for immediate payment, but you have to ask.

BERORE you go to all of this trouble, find out if you qualify for resurfacing. You can email your x-rays to Dr. Gross and fax your bone density scan to him ( your PCP will have to order this). If you are not a candidate you can find many OS's in Virginia in you medical plan to do THR.

I hope this helps.

[Roger P]

xocy: Thank you so much for your experience and for the link to Dr. Gross; his information on costs is exactly what I was looking for, especially where he explains why some costs are higher than others and how rates are negotiated. VERY helpful, and I recommend anyone confused about costs and insurance download the PDF file he has on his site under the Insurance link. Also, Dr. Gross is out-of-network for Aetna -- but Providence Hospital in Columbia is in-network, so there are some definite possibilities to look into in the coming weeks. I agree that looking overseas at this point seems unnecessary. Good luck next month in South Carolina!

Pat, rim869: We are grateful to hear what you've been through. Right now we are just waiting for the holiday weekend to end so we can get down to phone calls and emails. I will definitely let the board know what I find out.

Thanks again,
Roger

[Pat Walter]

Hi Roger

You are welcome. I hope you do keep in touch.

Just as an aside - Since I am an older female at 63 with a loss of bone density - I would DEFINITELY travel out of the country to a really experienced surgeon like Dr. De Smet if I needed my other hip done.   None in the US are experienced like the overseas doctors. When there are really difficult hip problems, you need the really experienced surgeons and unfortunatly, they are overseas.  De Smet has done over 3000 hip resurfacings and McMinn & Treacy over 4000 hip resurfacings.  No one in the US can come even close to that. They are the MASTERS of Hip Resurfacing.

Dr. Gross has done a few resurfs that even De Smet has not wanted to do.  So sometimes in the really difficult situations, it is interesting to see how the top docs approach it all.

Give our US doctors a few more years and they will start to catch up.  When the hip problems are very complicated - nothing beats experience.

Just a little preaching based on reading hundreds of personal hip resurfacing stories!

Pat

[rlm869]

pat, i truly appreciate your experience, but when folks have insurance sometimes they just simply cannot afford to go overseas. there is no way i could pay out of pocket the amount of money you paid to go to de smet, even though it was low overall compared to costs in the united states.

[dgm]

I had RBHR with Dr. Rogerson on 2/14/08 and recently received my hospital bill which was just over $37,000.  But this included the the cost for the BHR "hardware" which about $15,000 of the total bill.  I have a high deductile, HSA eligible insurance policy so my out of pocket was $5500 for the entire procedure.  My policy also allows me to go to whatever doctor I choose, so that was a bonus.  I have not received the final surgeon's bill, but his fee was just under $9500 for the procedure.  When you add in the assistant, anethesia and all rehab related costs, I'm guessing it will total out around $55,000 - 60,000. 

Dr. Rogerson will do a consult based on your medical history and xrays at no charge.  You can find the link on this site, use the one for Meiter Hospital.   I traveled to Wisconsin from Montana and would go again in a second.  Perhaps Dr. Rogerson is in the network or your insurance company can work something out with the office. 

You are wise to do your research but find a surgeon you are comfortable with and do it.  Looking back, I think I would have paid any amount, by whatever means, to be pain free.  I can't believe I waited as long as  I did to have this surgery, but am so glad I did.

Good luck!
Denise

RBHR 2/14/08 Dr. Rogerson

[Tarhoo2]

RogerP,

Just read your post.  I live in Northern Virginia and have had two BHR's done by Dr. Andy Engh of the Anderson Orthopaedic Clinic in the last 5-1/2 months.  The surgeries were performed at the Inova Joint replacement Center at Inova Mount Vernon Hospital in Alexandria.  I have been extremely satisfied with the results, process and total experience and would highly recommend Dr. Engh.  Personally, I don't believe that a surgeon has to have done thousands of BHR's to be competent and capable, despite what you may read in these pages.  I would be more than happy to discuss my experience with you directly.

Jim

[fenceman]

Cost for BHR at Cleveland Clinic BEFORE INSURANCE ADJUSTMENTS was $67,000.00.  This included $19,000 for the hip parts and 3 nights in the hospital.  As far as I can tell everything was included.  I am waiting to see the insurance adjustments.  Bill

[obxpelican]

You can ask to be "pre-certified" so that you know what the procedure and hospital will cost you.  Providence hospital NE was able to get me pre-certified and were able to come up with my share... I have a high deductable PPO through BCBS, my costs to the hospital was around $2,400.

Might be worth calling Dr. Gross's office and talk with their billing department, tell them what insurance you have... Dr. Gross is in SC, not too far from you, we drove through VA on our way from PA for my surgery.




Chuck

[Tarhoo2]

Roger,

Don't know if you all have made any decisions yet, but I will reiterate that I had BHR's on both hips done by Dr. Andy Engh (12/07 and 4/08) in Northern Virginia and am totally satisfied with the results.  My experience with Dr. Engh and the folks at Inova Joint Replacement Center has been outstanding.

My initial response to your question was not very helpful and I apologize for that.  To "fill in the blanks," I am insured through a BCBS PPO program.  I have not added everything up, but I would estimate that my surgeries, all in, ran between $35K and $40K each.  My out-of-pocket cost for each operation was probably less than $1500, maybe less than $1000.  Dr. Engh's office handled all the insurance matters and I am not aware of any issues with BCBS regarding coverage.

I would be more than happy to discuss any and all aspects of my experience with you directly.

Hope this is helpful.

Jim