Hi Paul,

Thanks very much for the info. However, I really would like to know what your insurance paid actually paid to the hospital and to other providers (the actual contracted price). In my case, the insurance company sent me an statement with figures requested by each provider and what actually the insurance paid out.

As I mentioned before, the hospital asked for $92,500 and the insurance paid only $8400 to them. Also, the real pay out for all other entities were much much less than what they asked for.

You can say my insurance company did a great job reducing the cost. However, I do NOT see it that way since low pay out put hospitals in financial crisis which results in cutting back to allocate funds for equipment upgrades and as such specially if the hospital is a "For Profit" hospital. My hospital in Phx is a non-profit hospital and has the best equipment for ablation and other procedures. Of course, most of the time we do NOT have any choice to choose a hospital for our ablation. We go to the hospital where the EP operates from. I was just lucky.

Thanks.

Happy Memorial Day,
Scott

Wow, this is all an eye opener for me. THx!

Here your are Scott:

Hospital $65,905.00 insurance paid $49,429.00
Anesthesiologist $4,140.00 insurance paid $2016.00
EP Surgeon $4,697.00 insurance paid $4140.00
Cardiologist $1,095.00 insurance paid $302.00
I have no copays for any of the above.
There were a few other small items that my insurance paid for in full since it was all under outpatient surgery.

As mentioned above, the pre and post op office visits and tests have a copay under my insurance this will come to about $500.00 out of pocket under my plan.

I have over $1000.00 in bogus bills. You need to follow up on each item that requires money out of pocket. Don't paid anything you have doubts about without a review with your insurance company. For example, there were two discharges from the hospital, one by my cardiologist and one by some nurse practitioner that my insurance refused to pay. I made the nurse practitioner eat it. Just tell them they are guilty of fraud. The there was a CT that was billed as two separate items. They tried to get an extra $200.00 from me. I'm working with my insurance company on this, I'm sure I will win. This afternoon I got a bill for $1628.00 from the hospital ...I have no idea what for. The insurance company paid $931.00, the hospital wants $290.00 from me. I'll track this down on Tuesday.

Don't be a wimp. Fight every penny that leaves your personal pocket! ALWAYS GET AN ITEMIZED BILL FROM THE HOSPITAL. They will not give you one unless you request it. They must give it to you.

Don't eat too much barbeque this weekend!

Typo flip what the insurance paid the EP Surgeon and the Anesthesiologist

I used to have a Humana Medicare HMO. My local hospital would not take it because Humana's payments were too low.
Now, I have a Blue Cross Medicare PPO. I have huge deductibles and co pays.
I best look into this!

Thanks very much, Paul.

I just can't understand what is the reason behind such a big discrepancy for payout amounts to hospitals. For your info, payout for my anesthesiologist and EP were very close to yours, but there is a huge difference between the numbers for the hospitals. I am NOT sure why. Does anybody know why? Please let me know.

By the way, after my deductible (5 K) , the insurance paid for everything.

Also, Paul, good advicel about checking the bills for mischarges. Fortunately, I did NOT see any extra charges for something that they did NOT do.

daisy0808,
Since your procedure was in Phx at a different hospital, would you tell us how much your insurance paid to the hospital. I am wondering if the payout depends on geography and where the hospital is.

Carol,
It is very HARD to get a sense for how much you have to pay before going through it. I tried hard without any luck. It all depends on contracted prices for various services, which nobody wants to tell you before your procedure. However, you should count on paying at least your deductible in full. Yes, it is jungle out there when it comes to medical stuff :-)

Scott

I keep thinking that if an ablation doesn't work, the hospital gets paid again for the next ablation. Doesn't seem right. They should get paid that huge amount to do a successful ablation. Most of the time, an ablation is really "elective", meaning you "could" pursue a different treatment. Or they could do "touch-ups for free or at a fraction of the cost. They don't charge you twice if they don't fix your car right. If payment was based on success, it sure would cut down on ablations that shouldn't have been performed. petey

petey,
Sorry, but I don't see the hospitals like garages that you take your car to get it fixed :-) Hospitals only provide the environment/equipment for a procedure, right? The success of a procedure also depends on the expertise of the doctor and how he/she utilizes the equipment. So, I don't think it is a fair comparison between the hospitals and auto repair shops, hahahahahaha. The purpose is the same, getting something fixed.

Also, based on your logic, the 2nd ablation should be totally free and nobody should get paid, right? I agree that there should be a discount for a 2nd procedure if the 1st one is not successful but NOT totally free.

Paul,
Is it possible that your insurance pay out to the hospital was 5 times as mine because you have a State (gov) run insurance as compare to mine which is a regular company? That is the only thing which comes to my mind. Of course, we know that the bean counters always play around with the numbers. For example, the car rental is always cheaper for an individual than a company. But, in reality that is NOT the case at all. It is only on paper since the car rental companies give back a percentage to companies at the end of the year based on some criteria. So, the company rental rates are actually much cheaper than what appears on papers. That is a fact. Any other thoughts?

Scott

Scott:
Yes, I do have excellent health insurance as a result of working for New York State government for 23 years (for terrible pay).

Keep in mind that about half of the hospital costs where for the catheters. There were several types of catheters used, and perhaps multiples of each type. The catheters alone were over $25K

Paul,
I am not sure if you realize that I had the same type of ablation as you did, catheter/cryo combo. Mine lasted 4.5 hours. So, my question is NOT about how good or bad our insurances are. My question is about the huge discrepancy in the amount of money that the two insurance companies paid to the hospital for the SAME procedure, ablation. I am just very surprised why such a big difference. Is it local or something else. I expected the negotiated/contracted payout to the hospital to be similar. Please remember I only paid my deductible (5K) and the insurance paid the rest of all costs for my ablation.

So, the question is why the negotiated prices were so different since my hospital is rated as the best heart hospital in Phx.

May be you are thinking that whatever my insurance did NOT pay, I had to pay. Simply, that was NOT the case. My total out of pocket for the entire year was 5K. So, my insurance was very good too. At least, I was very happy with it.

Any more ideas? :-)

Scott

Scott: I was just making a point. But then again, for $92,500 for 6 hours is a lot of money. The below article got me thinking this way though:

http://www.forbes.com/sites/frederickallen/2013/04/16/hospitals-make-more-money-when-they-mess-up-your-surgery/

petey

Scott:
Hospital costs (and reimbursement rates) are black magic. A few months ago I started a thread on that topic. Steven Brill (Time Magazine) has been doing a series of articles on the insanity of health care costs. The original article (3/13) was great (and 28 pages long). It seems to have been taken down from the web (probably)because 'THEY' do not want you to know). However, I managed to get a *.pdf or the article. I'll send you a copy if you send me your email in a message.

Scott here is what was billed and paid for me, I had already met my out of pocket so I paid nothing on these. EP seems to have got the short end of the stick here. Amazing what the hospital charges and the reduced contract fee. I have BC/BC PPO

Hospital $124,824.88 $27,621.16
EP $3,479.00 $1,908.02
Anesthesia $4,590.00 $3,196.00

My 2 cents: I have Kaiser of Northern California. I have looked at the insurance rates for Kaiser of Southern California. There's a huge difference in the costs between the two plans. What's the difference? A large part of it is the difference in wages and benefits. Cost of living.

Time devoted an issue to medical costs: http://time.com/198/bitter-pill-why-medical-bills-are-killing-us/ However you have to be a subscriber to read the whole issue or find it in a library. It's worth reading. The issue date is March 4, 2013.

Todd