Thursday, December 13, 2012

Cost of Surgery...sit down

Ok, I always knew that there was something wrong with my country's healthcare system, but you can't quite appreciate the dysfunction until you are actually confronted with substantial medical bills.

I have now received all bills for my surgery and DUMBFOUNDED at the huge difference between what is billed and what will actually be paid out. It makes me thankful that I have insurance and realize how unjust it is for someone, without insurance, to be billed the ENTIRE amount, when my insurance company and I don't come close to paying that amount. I know a handful of the top surgeons in this country don't take insurance and now I know why.

Below is a breakdown. My portion is 30% of the negotiated insurance rate. My annual deductible is $550 and maximum out of pocket is $5650 (Meaning, I don't have to pay any medical bills after I've hit $6200 for the year). I've had other doctor's appointments this year, so you'll notice my insurance company has to pay a bit more on the hospital bill b/c it maxed out my annual obligated amount.

P.S. I almost had a heart attack when I saw the hospital bill.

Surgeon Fee: 18,750.00
Paid by Ins.: 3,205.28
Paid by Me: 1,373.66
Difference: 14,171.06

Anesthesia Fee: 4,140.00
Paid by Ins.: 1,276.48
Paid by Me: 547.06
Difference: 1,769.04

Hospital Fee: 47,139.88
Paid by Ins.: 8,073.06
Paid by Me: 3,245.94
Difference: 35,820.88

TOTAL BILLED: 70,029.88
TOTAL INS.:12,554.82
TOTAL ME: 5,166.66
DIFFERENCE: 52,308.40


  1. ouch!

    I've been approved for my surgery, although they approved on a two piece Le Fort I and I'm worried that if it ends up being a three piece they'll change their minds. I've asked my surgeon and my insurance company and neither can give me even a ball park figure of what is billed and what I'll pay. My out of pocket max is $3000. I can't imagine if I didn't get approved going into this not knowing at all what I would be responsible for.

    I also maintain that Alice, the lady who handles insurance in my surgeon's office, is the most powerful woman in the Midwest. I can't even get through to the right department with my insurance but she is ON IT.

  2. Don't get too worried about the 2 piece changing into a 3 piece. The most important thing is that you were approved. I was only pre-approved for 1 night stay in the hospital and was actually rejected for the 2 additional nights. However, I stayed 3 nights and the insurance company ended up paying for it.

  3. OH MY GOSH!!!!!!!!!! I almost fell off my chair when reading that. MOVE TO CANADA!!!!!!! lol!
    I felt lucky only to pay $400 instead of the $2000 it was supposed to cost me. The reason I got this discount is because I am a patient with the university graduate orthodontist program. Also the braces only cost me $3200. Sorry not to sound like I am bragging, I just am in awe of what this surgery costs for Americans, and just telling you so others can compare the difference between our healthcare systems. Just nutty!

  4. What kind of insurance do you have, I am a college student looking to get open bite surgery so I don't really have money to afford it full cost. I might be able to afford that much though.

    1. I have Anthem/Blue Cross PPO with a $550 deductible.

  5. Did they make a big deal about the surgery, I have gone to a few orthodontists and they always tell me that the insurance wont cover my open bite surgery. Did you have to try to negotiate with them?

    1. It was actually easier than I would have thought. My surgery was deemed "medically necessary" from the start. It wasn't necessarily my open bite, but my extremely narrow airway. The imaging submitted to the insurance was from a profile, showing how my throat had an opening the size of a straw, due to my tongue and soft pallet being too far back in my mouth. The second image was straight on showing my nasal passages, which was also blocked.

      I'm not sure what type of orthodontists you are seeing, but make sure you speak to an office that has other surgery patients. I've read countless blogs and most are covered under insurance. Maybe start with a surgeon and get a recommendation for an orthodontist from them. My surgeon's office was the one who submitted my insurance claim at the start of my treatment. I got an insurance approval before I even got my braces on.

    2. Also, don't get discouraged and don't take no for an answer. Because you have an open bite, you probably have other issues (like I did) that the insurance company will see as medical problems.

      Good luck!