I Refuse to pay for his new.... | Arthritis Information

his new whatever...car, kids braces, peice of art work, gardener.

I need to have a C4-5 spinal fusion done so at the beginning of the year I saw a surgeon and talked about doing it.

Life happened, SIL ran away with her kids, I changed jobs, I had my hip surgery, I spent time in hospital with gastro, started my new job properly, yada yada yada. I also saw another surgeon for a second opinion.

Well this week I got the quote from the second surgeon of what I would have to pay out of pocket. That is, costs over and above what Medicare pays and my private insurance pays. For some reason he thinks he is worth almost ,000.00 of my hard earned finances.

Both of these surgeons have very good reputations and are excellent surgeons. The second one has a better bedside manner and spent a bit more time with me explaining things. But generally what they had to say was the same thing. Exactly the same surgery, same recovery time, same time in hospital.

The thing is, that the first surgeon, and the first quote I got for my out of pocket expenses was 0.00. That is 10% of the other surgeon's fees. I don't understand the difference. I was shocked when I got the second quote, how can he justify charging that amount of money for identical surgery. To me that is just greed. Plain and simple.

Today I booked my surgery...with surgeon number one. I can see forking out 0 for my operation, I consider that reasonable. ,000.00 is NOT reasonable.

something doesn't sound right...did someone drop or add a 0?i'd double check the 00 quote..sounds like at least one of the insurances wasn't factored inWhy do you automatically think it is greed? It seems to me that maybe some insurance information is missing. Could that be the case?

You took an awful hard stance against the second surgeon. So what if he has a gardner, kids have braces. What does that have to do with anything?

Sorry it has been so hard for you recently Pam. Seems like we get into these cycles and can't get out sometimes. Hope this is the last step to feeling better and to life getting easier.

I gotta say 0 for a surgery sounds outrageous to me --- outrageously cheap! I couldn't get my dog operated on in this country for 0. And honestly 00 might even been a bit low for many insurance plans here, if you have an 80/20 plan with a deductible.

Things are so different between our countries - we are complaining about high gas prices and yours is about twice what we pay! I guess it all balances out somehow.
The surgeon is allowed to charge over and above the 'scheduled fee'. What medicare pays and your private health insurance pays are set by the govt. That is what the 'scheduled fee' is. What the dr charges over and above is up to him. The second surgeon chooses to charge a very large amount. The actual cost of the surgery is approximately ,000.00. Medicare and Insurance pay out approximately ,000.00-,000. Over and above that the surgeon charges what he chooses.

Phats I was just having a rant. It just shocked me how far apart the quotes were. They both get paid the same amount from Medicare and the Insurance Company. It's what they choose to charge over and above that gets my goat. I just wonder what the justification is thats all.

Maybe you should ask him for a discount? Even when painting the house, I get scared taking the lowest quote. I am afraid they will short change somewhere to make up the profit (like cheap paint or not enough scraping). Maybe you should recheck the first quote too? After all maybe new liability insurance costs went up, inflation has been incredible. I doubt too that a quote from January would be guarenteed.

Sorry you have had such a hectic, surgerically challenged year.Well Pammy, the way it's presented, it sure does sound like a clear and simple case of greed. It wouldn't hurt though, to double check and make sure there wasn't a typo in that high quote. [QUOTE=Bird Girrl]Sorry you have had such a hectic, surgerically challenged year.[/QUOTE]

Well put.

lol story of my life!

I checked the first quote today again when I called the surgeon. It still stands. Both of the surgeons have excellent reputations and work in excellent hospitals. I have researched both of them. The second surgeon is involved in a lot of neurosurgery research. I think he might use his surgeries to fund research, or maybe charge more and do fewer surgeries so he has more time for research. I don't know. But they are both very well respected.

I have booked the first surgeon for October. I had booked it for last March but like I said, life happened. I'm glad I got the second opinion. It just firmed in my mind that the surgery is needed and it is the right surgery for me. I had wanted a disc replacement but the second surgeon gave me several good reasons why it might not be the best for me, the main one being RA. The second one being age. Its funny, when they talk about joint replacements they don't like doing them on younger people because of the need for revisions. With disc replacements, they don't like to do them on people older than in their 40's. Because I'm 50 and have RA, I wasn't a prime candidate for a disc replacement.

I'm hoping that the surgery will help with my headaches and neck and shoulder pain and numbness in my right arm when I carry anything.

And just to make today special..........my 24 year old daughter was finally (after almost 10 years of trials) diagnosed as Bi-Polar!!!! She finally saw a psychiatrist who isn't afraid to pin down a diagnosis. She will finally get to be treated for the right thing and not just depression. The psych is very confident that she will be able to get back to university and make big steps forward, steps that she has been having anxiety attacks about. She is happy that someone finally listened to her.

You've highlighted one of many of the ongoing "extras" we have to deal with in living life with r/a, and I've also been dismayed at the disparities between some surgeons' prices (like you, I've had various procedures done). My own medical scheme pays 200%

of medical scheme rates for any surgery. the surgeon i went to for a wrist fusion charged 300%. i made the mistake of assuming he wouldn't possibly charge more that 200%, but he did. so i paid for one third of the surgery's costs, which was considerable. on the other

hand, I have been very lucky to have been treated by top cardiologists and a cardio-thoracic surgeon at 100% of medical rates. at K Oz per op. that was a lifesaver, physically and economically!

appletown2008-07-25 08:10:33pammy416-

I'm confused. Are you American with Medicare and American insurance living in Australia? I guess Medicare pays in coutries other than the U.S.

Jan in the U,S.

[QUOTE=Jan Lucinda]pammy416- Jas-

Thanks. It must be Australian Medicare. Although American Medicare does pay in Mexico for Americans who retire there.

Jan

The govt. doesn't set scheduled fee for private insurance. The facility you go to has a contract with carriers, and they pay what the contractual fee schedule is.Maybe it's a typo? added one too many zeroes?Jan Lucinda it is Australian Medicare. I'm Canadian/Australian I've been here in Aus for 25 years. Medicare is our govt medical system that covers everyone in a public system.

Debrakay the govt sets a scheduled fee for all medical costs here in Australia. Then if you have private insurance that covers the small gap between the scheduled fee and what the actual fee is. Then if the doctor wants to charge more than that it is up to him.

So depending on the doctor you go to he can either charge the scheduled fee and just take what medicare pays him, or he can charge the actual fee and make a bit extra, or he can charge whatever he bloody well pleases and you can have out of pocket fees.

wendyr unfortunately its not a typo, both were itemised accounts.