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Cost of an appendectomy? Reddit user posts $55,000 bill
CBSNews.com ^ | January 2, 2014 | Michelle Castillo

Posted on 01/06/2014 10:28:50 PM PST by Daffynition

How much could hospitals charge in the event of a medical emergency? According to one angry Reddit user, his bill for treating appendicitis and the resulting appendectomy procedure was $55,000.

Twenty-year-old Nick Gonzales had his appendix removed at Sutter General Hospital in Sacramento, Calif. in October 2012. He later received a bill for $55,029.31.

(Excerpt) Read more at cbsnews.com ...


TOPICS: Business/Economy; Health/Medicine
KEYWORDS:
Mr. Gonzales posted: **I never truly understood how much healthcare in the US costs until I got Appendicitis in October. I’m a 20 year old guy. Thought other people should see this to get a real idea of how much an unpreventable illness costs in the US.**


1 posted on 01/06/2014 10:28:50 PM PST by Daffynition
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To: Daffynition

It says that 44k was covered by Aetna insurance. In reality, Aetna probably paid far less than that and he could probably settle the 11k balance for much less as well.


2 posted on 01/06/2014 10:35:58 PM PST by iowamark (I must study politics and war that my sons may have liberty to study mathematics and philosophy)
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To: Daffynition

That is a simple procedure in most cases.


3 posted on 01/06/2014 10:37:58 PM PST by SWAMPSNIPER (The Second Amendment, a Matter of Fact, Not a Matter of Opinion)
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To: Daffynition

My son had an appendectomy the right after college. He had no insurance. The county picked up the bill. I think it was $4500 or something like that. He was at that time indigent.

He had to sign papers that he would repay the county...

A year later he had a software developer job,and was making good money.

Checkbook in hand, he tried to settle up and found that there was no protocol for accepting his check. Apparently no one had ever done that before.

(they finally did accept his money however)


4 posted on 01/06/2014 10:42:16 PM PST by babygene ( .)
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To: iowamark

How can you find out what Aetna actually paid? A FOI?


5 posted on 01/06/2014 10:45:34 PM PST by Daffynition (It isn't what we don't know that gives us trouble, it's what we know that ain't so.)
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To: Daffynition

His insurer might tell him.

The Freedom of Information Act deals with government, not private companies.


6 posted on 01/06/2014 10:49:06 PM PST by iowamark (I must study politics and war that my sons may have liberty to study mathematics and philosophy)
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To: iowamark
It says that 44k was covered by Aetna insurance. In reality, Aetna probably paid far less than that and he could probably settle the 11k balance for much less as well.

That's not the point.

The point is, there should have been a hi-res McDonald's menu board in the admitting office showing the hospital's internet price list of what each procedure costs. Gonzales should have been able to put "appendectomy" into Google Shopping and get a price list. It should have been like shopping for a smart phone.

7 posted on 01/06/2014 10:50:28 PM PST by cynwoody
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To: Daffynition
that's because the price of healthcare is not based upon charges for service to the customer, it is based on the cost to operate a hospital spread out between insurance providers. The cost of individual Healthcare is determined by the amount that the hospital has to gift to the government to cover medicaid,

when a doctors office or hospital gets an insurance card their eyes light up like they just won the lottery , even if you just came in for a prescription for antibiotics it will cost the insurance company about $1500 for the 15 minutes of service they provided

8 posted on 01/06/2014 10:51:40 PM PST by KTM rider
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To: cynwoody

It depends on how acute his appendicitis was. Did he have time to shop around? Did he know that his doctors would want a $7,000 CT scan?


9 posted on 01/06/2014 10:57:35 PM PST by iowamark (I must study politics and war that my sons may have liberty to study mathematics and philosophy)
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To: iowamark

Actually, in California the law says that once the provider has accepted payment from the insurer, the provider can no longer pursue payment of the remaining balance from the patient.


10 posted on 01/06/2014 10:59:19 PM PST by Benito Cereno
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To: Daffynition

Should have flown to Thailand, India and had it done for $7500 including hotel & flight.


11 posted on 01/06/2014 11:02:56 PM PST by entropy12 (Great republics wither when more people figure out they can get free stuff by electing socialists.)
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To: KTM rider

I know...I was taken by ambulance to hospital after suffering a heat stroke and first thing they wanted me to show the insurance card.


12 posted on 01/06/2014 11:04:48 PM PST by entropy12 (Great republics wither when more people figure out they can get free stuff by electing socialists.)
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To: KTM rider
when a doctors office or hospital gets an insurance card their eyes light up like they just won the lottery , even if you just came in for a prescription for antibiotics it will cost the insurance company about $1500 for the 15 minutes of service they provided

Now that's funny right there, I don't care who you are. And it's funny because so far from reality as to be laughable! My happens to be a CPC ( certified professional coder) and does medical billing for both physicians and what Doctors receive from insurance companies for services is so far your number as to be silly, and you seem to not consider that the Doctor has to pay ridiculous malpractice insurance rates, office and equipment fees, payroll for their employees, etc.

13 posted on 01/06/2014 11:05:20 PM PST by Mastador1 (I'll take a bad dog over a good politician any day!)
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To: iowamark
The question to ask is, why is the health care market so different from healthier markets, such as the market for smartphones or lawn care or body work?

Why is it that Obama, Pelosi, and Reid chose to push the health care in exactly the wrong direction?

Government toilet seats famously cost $600. How can any market run by the government provide us with accurate prices?

14 posted on 01/06/2014 11:08:29 PM PST by cynwoody
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To: Daffynition

I blame the hospital more than the doctor. I love how many hospitals now present you with a gift basket full of little things you might need like Kleenex and Tylenol and gauzes and soap but what they don’t tell you is that cheap little basket with under $5 bucks of true value they will charge something outrageous like $500 to your insurer. The Tylenol alone will be priced at more than $100 for two tablets.

I understand the hospitals get screwed in their own ways but there is just no excuse for that type of built-in fraud.


15 posted on 01/06/2014 11:10:43 PM PST by OrangeHoof (2001-2008: "Dissent Is Patriotism!" 2009-2016: "Dissent Is Racism!")
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To: KTM rider; Daffynition

My wife needed surgery for carpel tunnel syndrome. I don’t remember the total cost, but I do remember the billing “procedure.” When we showed up at the hospital, we pre-paid an “estimated copay” as they claimed they didn’t know exactly how much the insurance company would pay and how much we would pay.

The surgery itself went very well — including the time spend for the anesthetic to wear off, she spent about 5 hours there, just long enough for lunch. Within 30 days, we received the hospital bill showing a list of charges, how much the insurance covered and how much we owed (much less than our prepayment).

A few weeks later [so almost two months after the surgery], the hospital called my wife to confirm that the cost “was less than we estimated” and mailed us a check for the difference.

A month later [now three months after the surgery], we received another bill from the hospital showing charges for “anesthetic” with how much the insurance covered, and how much we owed (since we no longer had a prepaid balance). I wrote them a check.

A month later [now four months after the surgery], we received another bill from the hosptial for “nursing services” apparently for the 5-hour use of their facilities and eating their lunch. This bill also showed how much the insurance covered, how much we owed, and I wrote them another check.

At this point my wife asked me how many more bills we were going to get from the hospital, whether our total amount was now larger than, smaller than, or equal to their original estimate, and why they couldn’t send us just one bill listing everything. I had no answers.


16 posted on 01/06/2014 11:25:00 PM PST by TennesseeProfessor
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To: OrangeHoof

The excuse for that fraud lies in the nature of for-profit healthcare. Anyone who thinks that simply lettting the providers and insurance companies ‘self regulate’ hasn’t seen a real medical bill. My wife’s breast cancer cost us 18,000 and that was with ‘great’ insurance and negotiations between us and the hospital to our share of the bill.
The toughest part to swallow was being billed for ICU due to the butcher the insurance company would only approve to do her reconstruction following the mastectomy.
And the wait of 3 months following finding three tumors in her mammogram, because the insurance company needed to decdeif mastectomy was necessary and cost effective was a nice added touch.


17 posted on 01/06/2014 11:30:28 PM PST by AnAmericanInEngland
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To: Daffynition

18 posted on 01/06/2014 11:31:15 PM PST by JoeProBono (SOME IMAGES MAY BE DISTURBING VIEWER DISCRETION IS ADVISED;-{)
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To: TennesseeProfessor
There's a hell of a of lot bean counting going on there. A non-pathological market system would have erased it. You'd never see it. You'd pay $X for the whole deal, and that would be that.

But with government care, it's essential. And you're going to pay for it, one way or another!

19 posted on 01/06/2014 11:45:56 PM PST by cynwoody
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To: iowamark
I had an emergency appy in 2011. Spent one night in the hospital. The bill came to $45K. Thankfully my out of pocket was around $1100, which I paid gladly.

Of course that was back when I had good insurance.

You know the "junk policy" that didn't have 10K deductibles, which I am SO grateful to Obama for

20 posted on 01/07/2014 12:11:13 AM PST by boop (Liberal religion. No rules, just right!)
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To: OrangeHoof
I understand the hospitals get screwed in their own ways but there is just no excuse for that type of built-in fraud.

About 60 years ago I read an interview of the President of the Hospital Administrators association and he admitted that they overcharge patients that have insurance in order to cover the cost of treating patients that have no means to pay.

This government has been in the income redistribution racket for a lot longer than most realize.

In the early 60's my cousin had appendicitis that went septic and he spent 3 days in the hospital, his total bill for the surgery and the three days in hospital came to $300.00.

21 posted on 01/07/2014 12:26:42 AM PST by itsahoot (It is not so much that history repeats, but that human nature does not change.)
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To: boop

10K deductibles plus 35% of the cost?


22 posted on 01/07/2014 12:33:38 AM PST by MaxMax (Pay Attention and you'll be pissed off too! FIRE BOEHNER, NOW!)
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To: entropy12

Yeah. Cause an inflammed appendix can wait a day or two.
He probably would have had a nice cheap funeral in India or Thailand.


23 posted on 01/07/2014 3:24:04 AM PST by Kozak ("Send them back your fierce defiance! Stamp upon the cursed alliance! To arms, to arms in Dixie!)
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To: OrangeHoof

The surgeon would be lucky to see $800 dollars from the procedure. And that includes post op care.


24 posted on 01/07/2014 3:25:04 AM PST by Kozak ("Send them back your fierce defiance! Stamp upon the cursed alliance! To arms, to arms in Dixie!)
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To: Benito Cereno

Please provide statute or code to support that assertion.


25 posted on 01/07/2014 4:32:27 AM PST by nvscanman
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To: iowamark
In reality, Aetna probably paid far less than that...

According to the bill it was $45k in "payments and adjustments" so you're no doubt correct.

26 posted on 01/07/2014 5:02:50 AM PST by DoodleDawg
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To: Daffynition
How can you find out what Aetna actually paid? A FOI?

Cigna sends me a statement every time I go to the doctor. It shows what was charged, what they paid, and what I owe, if anything. I'd be surprised if Aetna doesn't do the same.

27 posted on 01/07/2014 5:05:20 AM PST by DoodleDawg
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To: Benito Cereno
Unless you sign a form that says you're responsible for the unpaid balance left over from the insurance company.

Very common here in IL. That practice started some years ago (within the last 5-10.)

28 posted on 01/07/2014 5:09:49 AM PST by usconservative (When The Ballot Box No Longer Counts, The Ammunition Box Does. (What's In Your Ammo Box?))
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To: cynwoody
The point is, there should have been a hi-res McDonald's menu board in the admitting office showing the hospital's internet price list of what each procedure costs. Gonzales should have been able to put "appendectomy" into Google Shopping and get a price list. It should have been like shopping for a smart phone.

He could have. This Site and a bunch of other similar sites would have allowed him to price shop hospitals in his area.

29 posted on 01/07/2014 5:10:22 AM PST by DoodleDawg
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To: DoodleDawg

Great, next there will be a priceline.com to help decide if one can afford that triple bypass or not. Maybe there’ll be coupons in the Sunday paper for 20% off......


30 posted on 01/07/2014 5:38:53 AM PST by AnAmericanInEngland
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To: AnAmericanInEngland
Maybe there’ll be coupons in the Sunday paper for 20% off......

Groupon. A $55,000 appendectomy for only $35,000. Limit two per customer.

31 posted on 01/07/2014 5:41:30 AM PST by DoodleDawg
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To: nvscanman; usconservative

See

https://www.americanbar.org/newsletter/publications/aba_health_esource_home/Lai.html


32 posted on 01/07/2014 5:45:57 AM PST by Benito Cereno
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To: Kozak

Appendix, gall bladder, heart attack, stroke etc are emergencies, and one has to pay local hospital whatever they want to screw you for.

I was just stating an example of cost difference for medical procedures.


33 posted on 01/07/2014 8:59:36 AM PST by entropy12 (Great republics wither when more people figure out they can get free stuff by electing socialists.)
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To: Daffynition

I had some cancer radiation treatments a few years ago. The bill was $55,000. However, Medicare would only pay a little over $5,000.

Apparently the hospitals are forced to eat the difference when it comes to Medicare patients but private patients or those covered by other insurance are required to pay the full $55,000.

I’m not sure what the true cost of the treatment including payments for the machines, doctors, nurses, etc. would be, but the variance means that pricing is not an exact science or everyone would be paying the same.

Perhaps the private patients with insurance are paying more to pay for the Medicare patients and a true cost for the treatments would have been in the $10-15,000 range.


34 posted on 01/07/2014 12:22:57 PM PST by wildbill
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