Author Topic: How much is surgery at New York Presbyterian?  (Read 4092 times)

Eddie

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How much is surgery at New York Presbyterian?
« on: October 23, 2015, 08:21:18 am »
Hi guys,

I just called my insurance company about what my befits cover and it's starting to worry me on top of the surgery recommendation by my doctors.

So they told me i have a $2,000 deductible. I have a $650 bill for my MRI scans which will be used towards the deductible. After the deductible is met, i'm responsible for 30% of all the bills.

This is where it's starting to worry me as i don't exactly have 30% of 200-300k? Could anyone please enlighten me if they had any similar situations with this?

Much appreciated, thank you for your time reading this.
-July 2015 - Woke up with congested left ear and lasted about 2 weeks - then came Tinnitus
-9/16/15 - ENT doctor diagnosed with Tinnitus
-10/2/15 - MRI Scan reveals 2.4 X 2.4 x 2.2 cm AN
-12/8/15 - Surgery NYP Dr. Michael Sisti
-12/9/15 - 100% tumor removal all nerves saved :D

CHD63

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Re: How much is surgery at New York Presbyterian?
« Reply #1 on: October 23, 2015, 10:33:09 am »
Hi Eddie .....

Although I did not have insurance issues myself, I would recommend you contacting the insurance department of the doctors you have chosen.  Many times they can intervene or at least help you go through the maze of additional approval.

Thoughts and prayers.

Clarice
Right MVD for trigeminal neuralgia, 1994, Pittsburgh, PA
Left retrosigmoid 2.6 cm AN removal, February, 2008, Duke U
Tumor regrew to 1.3 cm in February, 2011
Translab AN removal, May, 2011 at HEI, Friedman & Schwartz
Oticon Ponto Pro abutment implant at same time; processor added August, 2011

rupert

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Re: How much is surgery at New York Presbyterian?
« Reply #2 on: October 23, 2015, 08:07:32 pm »
Most insurance will have a max.  out of pocket dollar amount once your deductible is met.  For an example , I have a $1000 deductible and my max. out of pocket cost is $3500 for the year. Check with your insurance company.

Machia2332

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Re: How much is surgery at New York Presbyterian?
« Reply #3 on: June 28, 2016, 02:58:00 pm »
I work in medical billing, maybe I can make a few suggestions...

The hospital will likely have a financial counselor that you can meet with, utilize their advice as they will be familiar with the options available at their facility.  Most hospitals will have some type of financial assistance program available, even if your income is well above guidelines for state programs, anyone with a balance larger than $10,000 or so after insurance is billed is considered "indigent" meaning that most people wouldn't realistically be able to pay back the amount.  This very well could qualify you for financial assistance on the balance.   :)

Aside from financial assistance I suggest taking advantage of using any employer benefits available through your employer and/or your spouse employer.  If the surgery is scheduled for the following calendar year, elect for extra funds in Health Savings or Flex Spending accounts to help with the out of pocket cost.  (These funds are a pre-tax payroll deduction that usually saves around 30% that would normally be taxed out of your paycheck.)

Other options could include a prompt pay settlement.  (Most facilities will consider a discount in exchange for paying the balance quickly.). This discount could be on top of the pre tax savings that you get for using a Health Savings/Flex spending account.  The facility may also offer an interest free payment plan option.

The first option I mentioned is probably the best to look into. 

oh, now what

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Re: How much is surgery at New York Presbyterian?
« Reply #4 on: July 01, 2016, 05:38:03 pm »
Thank you for the info.

I believe House Clinic providers are not employees of the same system as St. Vincent providers, formerly Daughters of Charity California, a financially troubled hospital and recently purchased by Verity -- although their nurse-to-patient ratio and safety scores that I found have always been great. I see this independence as a tremendous benefit to us as patients, and hopefully to the providers as well, just don't need more conflicts of interest. My husband and I are retired, no employer insurance, but I have taken advantage of a Health Savings account (the stealth retirement account if you don't burn through it). How much these services cost is still almost always a surprise in the United States, and having to meet an in-network max AND an out-of-network  max is the kicker I am trying to reconcile. It would make sense to offer just a few care centers for people with serious AND rare health problems, less pressure and less tempting for providers to say "I can do that" when they just don't have the experience or the team to do it.

I will call billing people again for suggestions for my hearing on the 11th. One advocate emphasized using what the doctors say, and giving written instruction when admitted to the hospital as far as in-network providers. This just doesn't work with rare, serious problems and emergencies. God chose our generation to live through this. I'm hoping to work with others to manage it, so glad this forum exists.

Just an update--everything is paid now (made my out of pocket max) and my appeal was successful. Rita in the insurance dept. at House was VERY knowledgeable and helpful, and she loves what she does, how rare is that. Pay attention to what your docs say, it will be what you need in an appeal.
« Last Edit: October 30, 2016, 08:31:31 pm by oh, now what »
midfossa Wilkinson, Schwartz, Basta, Roberts @ House 4/13/2016, sticky 1.2 x 0.7 x 0.8, no pain ever, facial nerve preserved (camera cannot tell any difference) hearing not, age 64, walking 2 miles daily unless lightning, heat or ice--if you can, work up to walking 2 miles per day, the magic pill

caryawilson

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Re: How much is surgery at New York Presbyterian?
« Reply #5 on: July 13, 2016, 08:15:17 pm »
I had a 17.5 hour surgery at Hopkins and the bills approved for the surgery and hospital stay were around $120k. I had United Healthcare.  Note: I had 4 more surgeries to reanimate my face so this added another $80k or so

I agree that normally insurance is 30% until your max out of pocket limit. Mine was $5k but they can easily be higher. I would be surprised if you didn't have a max out of pocket.

Ask your hospital to preapprove the costs so you should have a good ballpark for your costs. If in fact, you have an unlimited max out of pocket, this would be in your and the hospital 's best interest.
4.5 cm, 17.5 hour modified retro surgery
John Hopkins: Lim / Carey
Complete Facial Paralysis
Facial Plastic Surgeon (amazing): Dr. Boahene