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medicare A out of pocket

titortrt
Posts: 5
Joined: Jun 2017

What  are  rough costs for  robotic removal of prostrate in Detroit area? I only have medicare A. Trying to figure  costs,  7 to 10 large?

VascodaGama's picture
VascodaGama
Posts: 2987
Joined: Nov 2010

RP is very expensive. Try getting an insurance to pay at least part of the costs or get it free checking at an health government organization.

Here is a link on costs;

http://www.webmd.com/prostate-cancer/news/20140619/cost-of-prostate-cancer-surgery-varies-widely-in-us#1

 

Old Salt
Posts: 720
Joined: Aug 2014

I agree with Vasco that it will be expensive. How expensive (Medicare A only) is impossible for us, outsiders, to say. I would suggest to ask the surgeon who will do the robotic procedure, assuming there are no complications. Unfortunately, I doubt that you will get a reliable answer. 

Presumably, the surgery will take place in a hospital. Medicare A covers only room and board, as far as I know. EVERYTHING else will be charged to you. Typically, the gross charges (billed by the hospital) are never paid by the insurance companies. But since you won't have insurance, you may be charged the full almount. Ridiculous of course! 

leamon
Posts: 39
Joined: Jan 2012

You should have received a book that gives the amount Medicare pays for various things.  You will have to pay 20% of what Medicare approves and they pay 80%.  Like said above, you are on your own for the Dr. bill if you only have part A.  I think part A covers everything but the Dr. but I am not sure since I have an Advantage plan.

leamon

 

Grinder
Posts: 438
Joined: Mar 2017

I have the hospital billing invoice for the prostatectomy I had done in the Indianapolis area. Keep in mind this is direct billing to my insurance company, I believe you can negotiate with the hospital to lower cost if you are paying yourself, on Medicare, on Medicaid, or belong to a cost sharing ministry like Medishare or Christian Health Care Ministries. The insurance company did all our "negotiating" for us...

Summary of Service 06/20/16

Room and Nursing Service... 2145.00

Pharmacy.....                            3643.00

Supplies....                                4533.00

Pathology.....                            1675.00

Surgery Service....                 39488.00

Anesthesia....                           2705.00

Recovery Room Service...      1528.00

TOTAL CHARGES...              55717.00

THEN further down are the following figures:

Negotiated Insurance Discount...  - 34324.53

Payment Anthem...                           -19313.16

So, after the "negotiations" between the hospital and the insurance company, Anthem paid some $20,000.

THEN there were the seperate billings of the surgeon and the anesthesiologist. The above are the hospital charges only. I believe the individual professionals and technicians added up to another $10,000 or so. So if you add the hospital charges to the surgeon et al charges it came out to around $30,000, of which through copays and deductibles we paid around $7000 on the RP. 

Its wise to get it all done the same year. In 2016, I had 3 ER visits, a colonoscopy, the biopsy, the prostatectomy, and endoscopy, a visit to Ortho Indy for unrelated muscle tear, not to mention all the doctor/urologist visits. This way we paid one year's deductible for all the procedures, rather than deductible every year. 

So, in short, the unnegotiated total was some $65,000. After, it was some $30,000. I don't know how Medicare handles the discount negotiation. The reason the charges were so heavily discounted is because this hospital was in the "network" of OUR insurance company. If the hospital and surgeon had been "out of network", we would have had to pay substantially more of the total charges without nearly the discount. I have no idea how much more, but substantially more. So of course, we found the best surgeon and hospital in our " network ".

Hope that helps. 

Old Salt
Posts: 720
Joined: Aug 2014

I will emphasize that your hospital and surgeon may charge (a lot) more or less. But you can (and should) negotiate the bill presented to you. In fact, hospitals may have a specific ('financial aid') office to help patients. 

In summary, do NOT pay the billed amount, and negotiate for the Medicare allowable amount or the amount that the insurance system would pay.

Grinder
Posts: 438
Joined: Mar 2017

These unnegotiated costs, even with the discounts, these costs seem exorbitant. But keep in mind the cost of malpractice insurance, and the malpractice attorneys you see every day on TV and media. Those innumerable attorneys have gotten rich suing hospitals and doctors, and the settlements of those cases, and the increases in malpractice insurance, are being passed on to us, the patients, in the form of exorbitant hospital charges.

Sure some of the litigation was necessary, but let's not kid ourselves. We live in a very litigious get-rich-quick society, where the rest of us are hurt in the long run by the greed of the injury lawyers and their clients.

I myself am self employed in the saw and tool business, hence the "Grinder"....(yes, I really do a lot of grinding, for real). And i am paying for product liability insurance annually. My largest company customer, a brass mill in Ohio, actually requires it to protect themselves in the event one of their guys gets hurt by a product I sold to them. So I am paying for liability insurance... 

A quick industry story to illustrate. A company in Oregon bought a 14" Systimatic carbide tooth saw blade from a mom and pop tool business. The boss in said company then put it on a Milwaukee 14" ABRASIVE hand held saw, gave it to an employ and told him to stand on top of a pile of aluminum rods and cut them in half. While attempting to do what the boss said, the rods slipped out while he was cutting them, he slipped out as well, and the carbide tooth blade cut clean through his collar bone. The employee's attorney sued the mom and pop store, Milwaukee the saw manufacturer, Systimatic the blade manufacturer, and probably more that I don't know about. The mom and pop store did not have liability insurance, so, even though they were not culpable in the accident, the legal fees still bankrupted them and they went out of business. Systimatic designed some specialty blades for us, that is how I know this story. I have others, but you get the idea. There are a lot of rich attorneys out there, somebody pays for those million dollar judgments, so the costs get passed on to us.

Grinder
Posts: 438
Joined: Mar 2017

OK I found the surgeon and anesthesiologist bills.

Laparoscopis Radical Procedure... 5610.00  (the surgeon's services)

Anesth Perineal Surgery....                3185.00  (the anesthesiologist)

Sooooo... Total unnegotiated out-of-network RP bill would be $64,512.00

                  Total negotiated in network RP bill would be $28,128.00

RobLee's picture
RobLee
Posts: 259
Joined: Feb 2017

I remember seeing the hospital bill and it was around $50,000 and the surgeon was around $5,000. I have medicare plus supplemental and paid nearly nothing for the RP, however my wife developed lymphoma last year and our out of pocket was around $7,000. And I used to work for a small business that distributed pet products and they were sued by a negligent customer who misused a product, so I know about the liability insurance thing too.

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