I have yet to get the EOB for my DD's last surgery but I did happen to see it on BC's website when I was looking for something else.

Her first surgery cost $8,000 and she had her colon removed only and an ileostomy created. She was too sick to have anymore done. This surgery last about 3 hours.

Second surgery "the big one" he (the surgeon)said, cost $10,000. This involved removing her rectum and creating the j-pouch and he got rid of the old stoma and made a new one (small hole though) higher in her small bowel. This surgery last 4-5 hours.

This last surgery, the easy one, per same surgeon, was billed at $16,000 PLUS his practice partner (who I don't like and would never have agreed to her doing anything on my DD) has billed us $3,200. This surgery was to remove about 2" of her small bowel (where the ileo was), poke it back in and stitch her up (which, stupid me though he was actually going to stitch her up and not leave the wound open. He never told me this). It lasted 45 min to an hour.

So who here thinks these prices are right? Oh and BTW we are paying these bills since he does not take our insurance (long story but didn't know this until after first surgery which was emergent).

So I would like to compare if possible (without using names of course) with those of you who had 3 step surgery in Los Angeles area in California. I know prices differ depending on where you reside etc.

This would really help me out and maybe either piss me off more or make me feel better. Right now I am a bit hysterical.

I would ask about a negotiated price, since you are not getting any insurance benefit (or do you plan to submit papers to your insurance company on your own for reimbursement?).

I would also call your insurance provider and ask what the usual and customary charge is for these procedures. That would be the best way to negotiate with the surgeon. Since he is out of network, you can expect to pay more because not only does he not accept your insurance, he is not paid a monthly stipend from your insurance (which is what is done for network providers). I hope the hospital was at least in network for you.

You should have been given prices up front since he knew you were not using insurance.

Your insurance should cover the first surgery because it was urgent/emergency type surgery and you did not have a choice. However, subsequent surgeries could have been done by a network provider, but can't change that now.

Jan

Kristen,
Hi, I just read your post regarding your daughter. Does she have Blue Cross PPO insurance?

Thanks Jan. I am pretty savvy with all the ins and outs of billings. We knew after the first surgery was done that he was OON (didn't know prior to 1st surgery). I have been able to work with our ins to cover roughly 47% of the last surgery (I'm a good talker! Originally they only paid like $1,200 or so). But it has been a case by case basis for getting them to increase their payments. So whatever the left over amount is, he usually will give some discount (on average 20%) and the rest is ours to pay. So there is no add'l negotiating (he actually refuses to talk about money). Yes, the hospital was in network, thank God!

He did help our daughter and we will forever be grateful. I just want the billing to be appropriate too. We have no problem paying (well mentally, but actual paying will be payments!!) for what is fair, KWIM? This doesn't seem appropriate at all.

BlmBlp - Barbara

How did you guess? I know in the last few years BC has really been screwing pts & doctors alike over. But it is all that is offered at my husband's job, BCC PPO or HMO. And with my DD's health issues, mine (IDDM on pump) and my other daughter (lots of neuro disorders) we need to stay with PPO of course.

Hi! I, too, live in Orange County, CA. I am so very sorry your family had to go through all this. The costs sound reasonable but there are a number of excellent surgeons in our part of the country who take ALL kinds of insurance. Wish I had had a chance to connect with you earlier. Are you still looking for a wonderful "follow up surgeon" who takes your daughter's insurance? If so, please e-mail me and I'll see what I can send to you in the way of information. cemaurice@roadrunner.com

Hi I had my surgery done in LA because this is where I live and have the same insurance. My surgeries were planned and I choose to use and out of network surgen because felt like people spend this much on plastic surgery. I had two surgries and the office told me the cost and we tried to get blue cross to tell us how much would be paid by them but they kept on messing up the forms or not getting them. I decided to go for it anyways. Both surgries cost the same, the first one with all the work 5 hours and the second one just to connect they bye pass 1 hour 2 months later. The insurance almost paid nothing which is rediculious considering how long the surgery was. My surgen also had a partner. They also gave me a discount but it was still alot of money some where in $16,000.00 dollar range. I used a in network hospital and ended up staying the first time for 12 days at a total cost of $95,000.00 dollars. With no negotiating it was written down to $2500.00. Paid nothing for the second stay about 4 days because I had met my out of pocket maximum. My surgen is great, calls me back, talks with my GI Dr. all the time about my situation and at a certain point at the end of the year for patient visits they put me on insurance only. They send me bills but were very easy to work with for payment. I choose who I felt was the best surgen. I am 45 had UC for 10 years had been really sick for the last 3 years. I have a 4 1/2 year old son who is autistic and he and my husband and my 80 year old mother need me to be healthy. I am stil having problems but I have no regrets. Both he and my GI dr are totally attentive. Unfortunately here in LA sometime you have to use an out of network Dr. if you want them to call you back in a reasonable amount of time. Sorry to go on so long

Mariannne