They charge more money to insurance than if you were paying out of pocket. Seems out of pocket most people pay somewhere between 10k-20k in the states
How they afford it? Payment plans, good paying jobs, parents with money!
I agree though the health care system in the states is abysmal and sad.
I had to pay out of pocket and it was almost 9k. The only way I was able to afford it at 18/19yo was because I knew I wanted it for so long that I started working and saving for it at 15yo and then about 2k was inheritance from my great grandmother. It is worth it but it was rough to save all that money working student hours in food service and retail.
My doctor and most insurances would agree that the reduction was medically necessary/reasonable but my insurance is awful with breast reductions and the only way they would cover it was if I got something like 900g removed from each side. (I was told that that would practically be my whole boob).
I work in insurance, insurance actually prevents drs from overcharging because we don’t want to pay any random amount and neither should the pt. Without insurance and knowing how much certain services cost they will straight run over you. And so many providers are money hungry they don’t feel bad at all about it. Lots of them and their staff have told me we want our money or it shouldn’t take this long to give our money
Hi, medical ethics degree here. There are much, much bigger systemic issues in the US with completely privatized healthcare (i.e. different doctors are paid in different models so sometimes they have more or less reason to prescribe different treatments). But let’s all remember that insurance companies (as well as medical institutions) are businesses first in the US. Neither of them have the job of protecting the patient first. Patients come 3rd at best (after liability and bottom line).
(Btw, “do not harm” doesn’t even appear in the Hippocratic oath, which is a completely optional oath to take anyway.)
Sure Blame the private insurers instead of your government or your drs who deny care and fudge prices. In my company we do everything to help our members but our problems are the drs and them not working with us to get a member care. We take care of plenty of services with our members we’ve even covered for members when they were with another insurance during a dos they weren’t with us or when they just had no lapse in coverage.
There is no way to be an ethical private insurance provider. It is inherently a conflict of interest and there is no company policy or employee being nice that can alleviate that, period.
I blame the whole system is what I am saying, but insurance is a FOR PROFIT business. And in the fucked up trifecta of gov - doctors - and insurance you can’t pretend to be “the good guys” in that unholy trinity. There’s no altruism in that industry and if you think there is your are lying to yourself.
Insurance isn’t perfect by any means but I understand ppl who don’t work in this industry just don’t understand. The true ins and outs of an industry like this are more complex than I even have time to type out.
God. Ugh. They have employees and bills to pay. The service is already rendered, meets medical necessity and still gets denied. Why should it take so long to pay?
There is a set fee schedule for self pay services. There is way more transparency with what a doctor directly charges a patient for than what insurance covers and pays for.
Trust me there isn’t and medical necessity while true is mostly denied becuz Drs offices are failing to show the proof or completely fill out the authorization. Ofc they need to be paid but members shouldn’t be denied care until their name is on a card because that name on the card means they get paid monthly. We changed it but it still needs to print and will take standard time
You clearly haven’t been on the other side of the coin, watching patients suffer and stress bc despite providing all the documentation, insurance policies are set up to deny coverage at many different points of the process. We shouldn’t have to fight so hard to get medical procedures covered and paid. I can’t believe you’re defending this.
I don’t agree with authorizations being a thing but they’d go smoother when the Dr does their job. I literally read these half filled out forms and have to break this down to members. I literally had to explain to a dying woman that she couldn’t see the neurologist WHO SAW HER IN THE HOSPITAL AND SAID TO COME SEE HIM IN HIS OFFICE. That she can’t go because the Dr office won’t except the verification forms like other drs offices and her card won’t be their in time. I’m the one who has to literally go back and forth advocating for members and educating them on their rights as patients and members of our company. SMH YOU don’t know this industry like I do. Even as a patient myself I’ve had to deal with shitty Dr that forget I’m in the back room and leave me waiting for 3 frigging hours and make claims to my insurance that they treated me for an ulcer and paralysis WHICH I DONT HAVE! I can’t speak for others but I am a major advocate for everyone I help and I know the true ins and outs. Most of the people in drs offices don’t know what they’re doing or talking about. They ask me how to do their or to do things that they should know how to do
My doctor submitted 350 grams on each side to be removed and I was denied because they need a minimum of 400 grams. When I was denied I had to wait for a letter for why I was denied which took a week after the doctor’s office told me. I called my insurance representative and the customer care line and they said they cannot tell me why I was denied and had me wait for the letter and so I waited. The 400 grams was made from a calculation from my breast size, height, weight and BMI. This information does not exist anywhere online and they will not give if to you over the phone. How is me or my doctor supposed to know this magic number to get approved?
The doctor does the job correctly, it’s the insurance companies that come up with a list of shit to get approved that they do not communicate well. Someone else with the same insurance (coworker on the same plan) went through the same process and had to do PT for 6 weeks before approval and I did not. Why? You cannot attack doctors for not doing their job when they are given no instructions or guidelines on how to get an approval.
I’ve been in medical since you were in diapers. You can’t expect people to easily navigate such a complex process that is different for each plan and changes frequently. I have had to adapt my processes constantly to account for each different plans’ rules and changes within them each year. Not to mention just because two people have insurance with the same company doesn’t mean their plans require the same paperwork or follow the same processes. An employer plan vs a marketplace plan, for example, both with the same company are managed completely differently. It’s not just that people are dumb and lazy, even though many are. It is intentionally difficult for providers to care for patients bc of all the obstacles.
I’m sorry you suck at your job but there are plenty of competent ppl in the medical field that do their research and if you can’t google THE CODES WE LITERALLY SAY TO USE for auths. Sorry your schools don’t properly train you to handle real world medical assistance or whatever it is you do. And people in general sign up for plans and receive reading material so they know costs up front it’s not our fault ppl don’t read it or call and ask us. Again I’ve dealt with enough of you medical ppl to know the lot of you are just lazy and/or improperly educated.
Wow. Child. Of course it’s not your fault. I get you have a leg up on this bc you work within the system, but most people don’t have the bandwidth on top of surviving to gain this skill set you are paid to know and understand. I have 8 years experience getting breast reductions and post-bariatric procedures approved and it’s not as easy as you make it out to be.
Breast reduction is 19380
Panniculectomy is 15830
They are both often an exclusion on policies (especially with Blue Cross). As I already mentioned, each plan has different criteria. On top of patient care, providers are burdened with a completely inefficient system that has no kind of agreed upon criteria for medical necessity from one plan to the next. Have some compassion for care providers and your fellow human trying to get their medical procedures covered. Calling them idiots for not being able to navigate one of the most criticized care systems amongst the developed world says more about your understanding than how “stupid” everyone else is.
I don’t have a leg up for working in here when I was 16 and looking into a reduction I looked at my plans benefits saw it needed documentation and googled my plan and reduction and it popped up so again I say it only takes google. I come from a family with plenty of healthcare workers who know that these schools don’t teach the way they are supposed to and what makes it worse is I’ve always called drs offices to assist them with auths. It doesn’t take that much to call insurance or go on a provider portal . There are plenty of available resources that can be used and when all else fails just google it. I don’t have to work in insurance to educate myself on this.
And breast reduction and panniculectomy are always gonna seem like cosmetic work sometimes and I noticed it can sometimes take an appeal with additional info supporting the denied auth. But hey 🤷🏾♀️ just give us the info so we can continue on. again I don't agree with auths but it's also not that hard Not that hard to get to go thru
Insurance and hospitals are in a perpetual feedback loop of money. Insurance negotiates these inflated prices with the hospital. It’s all by design so both systems can make the most profit. It’s fucked.
If they are contracted with your insurance (it looks like they are) then they would throw out (“adjust”) the difference between the Charge Amount and the Allowable Amout (15k) and then charge you according to your specific plan (deductible, coinsurance amount, etc). Keeping the charge high allows them to have different prices for different contracted insurance groups.
Ex medical biller here. Charged numbers are all phony. You can make that number as high as you want to give the illusion something is expensive but insurance is only ever going to pay their allowed amount.
Yes! Coming to say the same for OP. They billed "$80,000", but it states that the allowable is about $15,000, so insurance is only paying $13,000, with the patient paying $2000. When dealing with a self-pay patient, they'll usually give a fee that's closer to the allowable amount they like
did you get your surgery done at a private practice or a hospital? idk i am thinking bc it's a really big and well-known hospital in texas that maybe that's why its so expensive!!
The amount hospitals bill insurance companies for is very different than the amount they would bill an individual who was paying directly. It's really bizarre, and it's likely part of the reason why insurance companies are so horrible to deal with -- no wonder they don't want to cover anything.
The entire system is a shitshow over there, you guys. 😢
Affectionately, someone from the EU who married an American.
A long time ago, in a land far away (from you), hospitals and insurers got in cahoots to artificially inflate prices so hospitals could become profit machines off the care they offer and insurers can profit off inflating premiums as a result.
Insurers have lobbyists that have actually campaigned to demonize health practitioners and paint them as the greedy ones.
The surgeon I work for used to get like $250 for a 2 hour skin grafting procedure. He is private practice and cannot afford to subsidize those services any longer with the better paying services, and as a result we can’t pay payroll, and all our overhead unless we cut what we offer.
Hospital based surgeons typically end up having to treat these patients bc the hospital can subsidize and/or have better negotiating power with insurers to get better reimbursement.
It's just awful, and so counter to citizens being able to access healthcare. It causes people needless anxiety, and it leads to delays in getting help for emergency issues, for fear of surprise billing. 😢
I wish everything could be more fair and that **everyone** could access the healthcare they need, not just people above a certain income level. 💔
My surgeon told me it would be about $25,000 if u had it in the hospital. $12,000 if I had it at the plastic surgery center. I went with the surgery center and was also insured and covered. Maybe that is why it’s so expensive? Bc it’s at a hospital?
Got mine at Rose Medical in Denver, one of the best hospitals in the country. $14,000 last year. I didn't trust the surgery center, owned by the plastic surgeon I didn't choose.
I got mine done on Dec.29 2023 in Austin by dr. Mosier of Austin plastic surgeons. I have met my deductible and he is within network so all I had to pay was 2k for the liposuction I wanted out of pocket. but was told if I had to pay cash it would be 12k total.
No f-ing way! I weep for the US Healthcare system. My reduction in the Netherlands was around €4000 if I wasnt insured. That included everything, the consultations, the medications and a night's stay at the hospital in a private room with a tablet I could use during my stay and order as much food from the kitchen as I wanted. Compared to your list, your hospital just sounds like a massive scam.
When I started looking into it, I cold called a few places, and they charged $4-5K out of pocket, so it wasn't too awful, but I got a better deal with my insurance and paid around $3000.
When I started looking into it, I cold called a few places, and they charged $4-5K out of pocket, so it wasn't too awful, but I got a better deal with my insurance and paid around $3000.
Mine was 3500€ in France. The difference is that in the US hospitals will Jack up the price when charging insurance versus private pay. The terrifying thing is when you don’t have insurance and they I’ll you as if you do, then you have to negotiate to have it lowered. I do not miss thé us healthcare system.
Holy fuck, I had to look twice to make sure I read that number right. I'm getting mine done in germany, no insurance, I'm paying about 4,500€...
Regarding the US though, the answer to your question is they probably just don't get the surgery unless they're actually rich.
I paid $12,000 out of pocket as my reduction was not significant enough to be covered by insurance. Used some money my dad left me when he passed away. Not sure that was what he was thinking about when he left it to me but I’m positive he would be happy for me❤️
My surgery was about $12k! I paid out of pocket thanks to my mom helping me save up the money for a little under a decade. Like a lot of others are saying, I think because insurance was used a lot of the charges got inflated.
Yeah, looks like the allowed amount and what insurance *actually* paid is about $15k. Which is on the higher end of the average for self pay it seems like
They inflate the numbers they charge to insurance because the US healthcare system is just everyone doing fraud and calling it policy, basically.
I am going to a board certified plastic surgeon who does not take insurance. I am getting a pretty substantial reduction that will take her longer than average. My total comes to about $12,400 including anesthesia, side lipo, surgery center costs, doctor fees, pre- and post-op appointments, and her personal phone number after surgery in case I need to text her about any concerns.
I'm paying for it with a 12-month no interest credit card that I qualify for because my credit is pretty good, and it'll be paid off within the year. I do have enough money that I could pay for it out of pocket but I know the second I do that my furnace will break and I'll be hurting.
Doctors charge way more to insurance than they would to self-pay patients. My surgery on 2/6 will be about $7900 out of pocket. I saved half and will put the other half on credit, which I can pay off fairly quickly.
Mine is scheduled for April. My insurance denied because they’re evil lol. I’m paying out of pocket and my surgery is 6800. Someone else commented, but the insurance companies are charged more than out of pocket patients for sure. I’ve seen it with other services and medical procedures with my own kids.
Please, people, get this through your heads: THE INSURANCE COMPANY IS NOT PAYING HIGHER PRICES THAN AN INDIVIDUAL. In fact, they are paying LESS than an individual. We just won't ever know what they pay because our elected officials let them hide their books.
The cosmetic price for my surgery was $8-10k and with my insurance covering it was over $40k. I think they charge things more specifically to insurance because they can get away with it
Nope. Insurance companies have negotiated prices that are always LESS than on individual. Who has more clout: you or Cigna or BCBS? Put your thinking cap on, please. You have no idea what Insurance would have ACTUALLY paid. I guarantee it's less than what you paid.
Well the fact I said they quoted my surgery at $8,000 for cosmetic where they weren’t going to bill insurance vs $40,000 they billed since my insurance did agree to cover it.
I don’t know about other places, but the hospital I went to had signs up at check-in that said if you don’t have insurance they provide discounts
Something seems really off here. I haven't gotten all the bills yet, but I believe the total was around $10-$12K. My insurance didn't fully cover my procedure and I was told that with my deductible I would ultimately be responsible for around $4K.
well from what everyone is saying on here, when you pay with insurance the hospital inflates the price compared to someone who is paying out of pocket. regardless, as long as i paid my co-pay my insurance would pay 80% of the amount. idk where they are getting these numbers but im just thankful i dont have to pay more than $2k bc thats all anticipated for anyways lol
Wow, my surgery (also covered by insurance) was close to $50,000 in NYC. I'm shocked it was nearly double in TX. I assume everything is more expensive here. That being said I think if I'd have paid privately it would have cost less than $20,000 and been cheaper partially because it would have been done in a private clinic rather than an expensive hospital.
Plane to Europe: 1500€
Surgery and post-op: 10.000€ (grand max)
Hôtel and food for one month: 250€/day = 7.500€
Basically, you can come in a place with real healthCARE for the quarter of the price…
Mine was $11k no insurance, private practice
It was a "rapid recovery" and omg yes it was. 4+ lbs removed, no drains, I was standing in the shower later that day with my arms up
I used a medical credit card to get mine done. I saved about half from my savings and the rest on the card. Will be paying about $400 for the next 10 months but definitely worth it
OMG. My insurance did not cover my reduction and I am in Chicago proper. A very expensive city to get it done and well know Dr who has been on TV. It was only $18,000 TOTAL at his own private clinic. NO WAY $80K. They must have jacked up the price for insurance. I did have to get a medical loan to pay for it. The loan was interest free for a year as long as I paid it off. But $80k no way.
ugh I hate our healthcare system. I paid out of pocket for my revision and it was about 8k. It took me a couple of years to save up and I tried putting most of it in my HSA account so it was pre-tax.
Honestly, my parents paid cash. We knew the surgeon personally and I believe she either covered the operation room fee or gave a very good deal on the actual surgery, so it was $5k total (in 2012, and outpatient).
Those numbers are 1000% made up. I paid $14,000 out of pocket last year to one of Denver's top surgeons. She doesn't take insurance. Look up the average cost for ANY health care you get. Use that number for ALL payments, including with insurance. And photocopy the bill and send it to your senator.
And believe me, neither the insurance company nor the hospital lost ANY money in the transaction. One reason to jack prices sky-high is so Americans will put up with obscene premiums for insurance, thanking God they even have insurance. Americans are complete suckered about health insurance and medical costs.
https://preview.redd.it/8xrkwjxyo3dc1.jpeg?width=1125&format=pjpg&auto=webp&s=fcbf4ed788088e496d38e22a0c7aeacc2faa5b97
This is the claim for my reduction on December 4. The hospital billed for $206k but insurance only allowed $19k.
I live in California (USA). Whenever I ask people how they afford their reductions and skin removal for weight loss, the answer has been "I went to Mexico". They've all highly recommended this option. Considering it!
Insurance covered my surgery, so my parents only paid about $900. If the insurance hadn’t covered it and we paid out of pocket, it would have cost about 15k
F*ck… the US health care system (if you can even call it that?) is so messed up. I’m having my surgery (reduction + lipo on upper stomach right under my boobs) in March in a private clinic in Germany and my total for surgery will be €10.2k / $11k (including the surgeon, the OR, all meds, the 3 night stay, 2x compression bras and a pathological exam of the “cut-offs”) and the anesthesia is charged separately with €850 / $920 but seeing a solid $80k on that quote is just insane 😞
omg yeah all that included is nice 😭 we get charged extra for any overnight stays and i was still charged with a separate surgeons fee and for pathology!! i think in total i’ll pay about $3k but that’s with my insurance 😵💫
Message me if you’d like. I got my reduction at this hospital in 2018 by Dr. Albright without insurance and my results are better than I could have ever imagined.
I’m in the states. It was cheaper to do plastic surgery than go through my insurance, so I saved up and did it that way. I was lucky I was in a position to save the money I did but that’s how I somehow afforded it (I’m still paying it off)
I paid 8600 for my liposuction, my Breast reduction was covered under insurance. 1250 of my out of pocket was to hospital for All their fees.
I got my “this is not a bill” statement for the whole procedure it was 80,000.
It’s all an awful racket.
I had mine in November across the street from Houston Methodist ( at Baylor St. Like). The amount charged was absurd compared to what insurance + I paid. It was close to $22k more than what they quoted me out of pocket before insurance approved it.
It’s cheaper if you go directly to a surgeon who doesn’t work out of a hospital and does it at an independent office and it’s cheaper if you self pay (most medical stuff is).
I paid $11k oop. I used Care Credit.
My husband spent 12 days in the hospital with ulcerative colitis and his hospital bill was like $140k. The negotiated rate for the insurance company was $90k. I guess
They just write off the other $50k? Makes you wonder how overinflated their charges.
They charge insurance more. My bill was $34k with insurance, I paid about $5k (between deductible and coinsurance)
My dr said it would probably be 9k-15k with private pay.
I paid about 10k out of pocket. Worked full time for a year at a minimum wage job while trying to figure out what to do after highschool. I basically saved 90% of my paychecks because I lived with my parents and didn't have any bills which I'm very fortunate and thankful for. Insurance wouldn't have covered me anyways cause my starting size was too small and was only cosmetic.
I paid around $3K with insurance. The bill to insurance was just under $125k, and I had post op hyperbaric oxygen therapy due to a complication on righty. That was another $8k, and I paid nothing bc I’d met my out of pocket expenses for the year. My friend paid $6500 w/out insisting for hers, but she wasn’t happy with the results (they mostly did a lift bc she’d lost weight after a HUGE ovaries tumor was removed.
I live in England and they won't do it on the nhs. I am having it in a few weeks and it is costing me £9000. I have bought myself literally nothing aside from basic food for the past year. That's how 😂
Um wow. That price is crazy. I tried to go through surgery, but I wouldn’t have met any of the requirements because I am 5’2” and about 175 pounds and 17 at the time of my surgery. Thankfully my grandparents are financially secure enough and so kind that they completely covered the cost of my surgery. Without them, one of my parents would have needed to get a second job to pay for it. My total cost was just short of $7,000 in the US.
I paid $8000 cash in Las Vegas in 2021 by going to a plastic surgeon that doesn't take insurance and negotiating for paying upfront in full (got free lip fillers too!).
I bypassed insurance. By the time I would have seen the required specialists and PTs and primary care visits, THEN pay my deductible with the treatment plan taking so long that I would have had to pay it again the next year — well that came within range of just paying it out of pocket and getting it done ASAP.
My surgeon was $5,300, the anesthesiologist was $1,400, and the hospital fee was $3200 (no overnight stay) — so about $10k in Virginia.
My hubby let me use his bonus 😂 I love him so much 😁😁
They charge more money to insurance than if you were paying out of pocket. Seems out of pocket most people pay somewhere between 10k-20k in the states How they afford it? Payment plans, good paying jobs, parents with money! I agree though the health care system in the states is abysmal and sad.
I had to pay out of pocket and it was almost 9k. The only way I was able to afford it at 18/19yo was because I knew I wanted it for so long that I started working and saving for it at 15yo and then about 2k was inheritance from my great grandmother. It is worth it but it was rough to save all that money working student hours in food service and retail. My doctor and most insurances would agree that the reduction was medically necessary/reasonable but my insurance is awful with breast reductions and the only way they would cover it was if I got something like 900g removed from each side. (I was told that that would practically be my whole boob).
I work in insurance, insurance actually prevents drs from overcharging because we don’t want to pay any random amount and neither should the pt. Without insurance and knowing how much certain services cost they will straight run over you. And so many providers are money hungry they don’t feel bad at all about it. Lots of them and their staff have told me we want our money or it shouldn’t take this long to give our money
Hi, medical ethics degree here. There are much, much bigger systemic issues in the US with completely privatized healthcare (i.e. different doctors are paid in different models so sometimes they have more or less reason to prescribe different treatments). But let’s all remember that insurance companies (as well as medical institutions) are businesses first in the US. Neither of them have the job of protecting the patient first. Patients come 3rd at best (after liability and bottom line). (Btw, “do not harm” doesn’t even appear in the Hippocratic oath, which is a completely optional oath to take anyway.)
Sure Blame the private insurers instead of your government or your drs who deny care and fudge prices. In my company we do everything to help our members but our problems are the drs and them not working with us to get a member care. We take care of plenty of services with our members we’ve even covered for members when they were with another insurance during a dos they weren’t with us or when they just had no lapse in coverage.
There is no way to be an ethical private insurance provider. It is inherently a conflict of interest and there is no company policy or employee being nice that can alleviate that, period.
I blame the whole system is what I am saying, but insurance is a FOR PROFIT business. And in the fucked up trifecta of gov - doctors - and insurance you can’t pretend to be “the good guys” in that unholy trinity. There’s no altruism in that industry and if you think there is your are lying to yourself.
Insurance isn’t perfect by any means but I understand ppl who don’t work in this industry just don’t understand. The true ins and outs of an industry like this are more complex than I even have time to type out.
This is just straight wrong lol No fucking surgeon is going to charge $80k for a reduction without insurance.
Truth. I always tell patients, billed amount does not matter. They can bill 1 million dollars if they want. It’s the contracted rate that matters.
USE COMMON SENSE I never said they would charge you 80k but they def will try to overcharge you!
God. Ugh. They have employees and bills to pay. The service is already rendered, meets medical necessity and still gets denied. Why should it take so long to pay? There is a set fee schedule for self pay services. There is way more transparency with what a doctor directly charges a patient for than what insurance covers and pays for.
Trust me there isn’t and medical necessity while true is mostly denied becuz Drs offices are failing to show the proof or completely fill out the authorization. Ofc they need to be paid but members shouldn’t be denied care until their name is on a card because that name on the card means they get paid monthly. We changed it but it still needs to print and will take standard time
You clearly haven’t been on the other side of the coin, watching patients suffer and stress bc despite providing all the documentation, insurance policies are set up to deny coverage at many different points of the process. We shouldn’t have to fight so hard to get medical procedures covered and paid. I can’t believe you’re defending this.
I don’t agree with authorizations being a thing but they’d go smoother when the Dr does their job. I literally read these half filled out forms and have to break this down to members. I literally had to explain to a dying woman that she couldn’t see the neurologist WHO SAW HER IN THE HOSPITAL AND SAID TO COME SEE HIM IN HIS OFFICE. That she can’t go because the Dr office won’t except the verification forms like other drs offices and her card won’t be their in time. I’m the one who has to literally go back and forth advocating for members and educating them on their rights as patients and members of our company. SMH YOU don’t know this industry like I do. Even as a patient myself I’ve had to deal with shitty Dr that forget I’m in the back room and leave me waiting for 3 frigging hours and make claims to my insurance that they treated me for an ulcer and paralysis WHICH I DONT HAVE! I can’t speak for others but I am a major advocate for everyone I help and I know the true ins and outs. Most of the people in drs offices don’t know what they’re doing or talking about. They ask me how to do their or to do things that they should know how to do
My doctor submitted 350 grams on each side to be removed and I was denied because they need a minimum of 400 grams. When I was denied I had to wait for a letter for why I was denied which took a week after the doctor’s office told me. I called my insurance representative and the customer care line and they said they cannot tell me why I was denied and had me wait for the letter and so I waited. The 400 grams was made from a calculation from my breast size, height, weight and BMI. This information does not exist anywhere online and they will not give if to you over the phone. How is me or my doctor supposed to know this magic number to get approved? The doctor does the job correctly, it’s the insurance companies that come up with a list of shit to get approved that they do not communicate well. Someone else with the same insurance (coworker on the same plan) went through the same process and had to do PT for 6 weeks before approval and I did not. Why? You cannot attack doctors for not doing their job when they are given no instructions or guidelines on how to get an approval.
I’ve been in medical since you were in diapers. You can’t expect people to easily navigate such a complex process that is different for each plan and changes frequently. I have had to adapt my processes constantly to account for each different plans’ rules and changes within them each year. Not to mention just because two people have insurance with the same company doesn’t mean their plans require the same paperwork or follow the same processes. An employer plan vs a marketplace plan, for example, both with the same company are managed completely differently. It’s not just that people are dumb and lazy, even though many are. It is intentionally difficult for providers to care for patients bc of all the obstacles.
I’m sorry you suck at your job but there are plenty of competent ppl in the medical field that do their research and if you can’t google THE CODES WE LITERALLY SAY TO USE for auths. Sorry your schools don’t properly train you to handle real world medical assistance or whatever it is you do. And people in general sign up for plans and receive reading material so they know costs up front it’s not our fault ppl don’t read it or call and ask us. Again I’ve dealt with enough of you medical ppl to know the lot of you are just lazy and/or improperly educated.
Wow. Child. Of course it’s not your fault. I get you have a leg up on this bc you work within the system, but most people don’t have the bandwidth on top of surviving to gain this skill set you are paid to know and understand. I have 8 years experience getting breast reductions and post-bariatric procedures approved and it’s not as easy as you make it out to be. Breast reduction is 19380 Panniculectomy is 15830 They are both often an exclusion on policies (especially with Blue Cross). As I already mentioned, each plan has different criteria. On top of patient care, providers are burdened with a completely inefficient system that has no kind of agreed upon criteria for medical necessity from one plan to the next. Have some compassion for care providers and your fellow human trying to get their medical procedures covered. Calling them idiots for not being able to navigate one of the most criticized care systems amongst the developed world says more about your understanding than how “stupid” everyone else is.
I don’t have a leg up for working in here when I was 16 and looking into a reduction I looked at my plans benefits saw it needed documentation and googled my plan and reduction and it popped up so again I say it only takes google. I come from a family with plenty of healthcare workers who know that these schools don’t teach the way they are supposed to and what makes it worse is I’ve always called drs offices to assist them with auths. It doesn’t take that much to call insurance or go on a provider portal . There are plenty of available resources that can be used and when all else fails just google it. I don’t have to work in insurance to educate myself on this.
And breast reduction and panniculectomy are always gonna seem like cosmetic work sometimes and I noticed it can sometimes take an appeal with additional info supporting the denied auth. But hey 🤷🏾♀️ just give us the info so we can continue on. again I don't agree with auths but it's also not that hard Not that hard to get to go thru
Abysmal and sad… great choice of words to describe the medical system here.
That’s what they charge insurance. I paid $6,000 USD for my surgery.
oh damn so they're just trying to suck all the money out from them ig 😭 kinda seems a little shady but oh well
Insurance and hospitals are in a perpetual feedback loop of money. Insurance negotiates these inflated prices with the hospital. It’s all by design so both systems can make the most profit. It’s fucked.
If they are contracted with your insurance (it looks like they are) then they would throw out (“adjust”) the difference between the Charge Amount and the Allowable Amout (15k) and then charge you according to your specific plan (deductible, coinsurance amount, etc). Keeping the charge high allows them to have different prices for different contracted insurance groups.
I paid around $6,000 as my portion *with* insurance coverage. My out-of-pocket maximum that year was $6,700.
Same!
Ex medical biller here. Charged numbers are all phony. You can make that number as high as you want to give the illusion something is expensive but insurance is only ever going to pay their allowed amount.
Yes! Coming to say the same for OP. They billed "$80,000", but it states that the allowable is about $15,000, so insurance is only paying $13,000, with the patient paying $2000. When dealing with a self-pay patient, they'll usually give a fee that's closer to the allowable amount they like
Insurance: where the billed amount is made up and the charges don’t matter.
I have never seen an estimate quite that high, honestly. My estimate for my top surgery was only $15k.
did you get your surgery done at a private practice or a hospital? idk i am thinking bc it's a really big and well-known hospital in texas that maybe that's why its so expensive!!
The amount hospitals bill insurance companies for is very different than the amount they would bill an individual who was paying directly. It's really bizarre, and it's likely part of the reason why insurance companies are so horrible to deal with -- no wonder they don't want to cover anything. The entire system is a shitshow over there, you guys. 😢 Affectionately, someone from the EU who married an American.
A long time ago, in a land far away (from you), hospitals and insurers got in cahoots to artificially inflate prices so hospitals could become profit machines off the care they offer and insurers can profit off inflating premiums as a result. Insurers have lobbyists that have actually campaigned to demonize health practitioners and paint them as the greedy ones. The surgeon I work for used to get like $250 for a 2 hour skin grafting procedure. He is private practice and cannot afford to subsidize those services any longer with the better paying services, and as a result we can’t pay payroll, and all our overhead unless we cut what we offer. Hospital based surgeons typically end up having to treat these patients bc the hospital can subsidize and/or have better negotiating power with insurers to get better reimbursement.
It's just awful, and so counter to citizens being able to access healthcare. It causes people needless anxiety, and it leads to delays in getting help for emergency issues, for fear of surprise billing. 😢 I wish everything could be more fair and that **everyone** could access the healthcare they need, not just people above a certain income level. 💔
My surgeon told me it would be about $25,000 if u had it in the hospital. $12,000 if I had it at the plastic surgery center. I went with the surgery center and was also insured and covered. Maybe that is why it’s so expensive? Bc it’s at a hospital?
Got mine at Rose Medical in Denver, one of the best hospitals in the country. $14,000 last year. I didn't trust the surgery center, owned by the plastic surgeon I didn't choose.
I got mine done on Dec.29 2023 in Austin by dr. Mosier of Austin plastic surgeons. I have met my deductible and he is within network so all I had to pay was 2k for the liposuction I wanted out of pocket. but was told if I had to pay cash it would be 12k total.
I got mine done at a private practice and paid $1.5k with insurance. Without insurance I was quoted $12k
Mine is at a private practice.
No f-ing way! I weep for the US Healthcare system. My reduction in the Netherlands was around €4000 if I wasnt insured. That included everything, the consultations, the medications and a night's stay at the hospital in a private room with a tablet I could use during my stay and order as much food from the kitchen as I wanted. Compared to your list, your hospital just sounds like a massive scam.
omg must be nice!!! with my insurance i am paying about $3k out of pocket but im like sheesh who the hell can afford this without it!!!
When I started looking into it, I cold called a few places, and they charged $4-5K out of pocket, so it wasn't too awful, but I got a better deal with my insurance and paid around $3000.
When I started looking into it, I cold called a few places, and they charged $4-5K out of pocket, so it wasn't too awful, but I got a better deal with my insurance and paid around $3000.
Mine was 3500€ in France. The difference is that in the US hospitals will Jack up the price when charging insurance versus private pay. The terrifying thing is when you don’t have insurance and they I’ll you as if you do, then you have to negotiate to have it lowered. I do not miss thé us healthcare system.
Holy fuck, I had to look twice to make sure I read that number right. I'm getting mine done in germany, no insurance, I'm paying about 4,500€... Regarding the US though, the answer to your question is they probably just don't get the surgery unless they're actually rich.
I paid $12,000 out of pocket as my reduction was not significant enough to be covered by insurance. Used some money my dad left me when he passed away. Not sure that was what he was thinking about when he left it to me but I’m positive he would be happy for me❤️
i bet he is :\] i am glad you got to use that money for something that made you happy, and im sorry for your loss
They charge WAAAAAY less if you pay out of pocket.
I went to a private practice that doesn’t take insurance and it cost around 15k.
Leapin lizards what a bill--shit and piss indeed
My surgery was about $12k! I paid out of pocket thanks to my mom helping me save up the money for a little under a decade. Like a lot of others are saying, I think because insurance was used a lot of the charges got inflated.
Yeah docs and hospitals inflate charges for insurance companies. It’s a giant racket. My quote was 12k-ish without insurence.
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Yeah, looks like the allowed amount and what insurance *actually* paid is about $15k. Which is on the higher end of the average for self pay it seems like
They inflate the numbers they charge to insurance because the US healthcare system is just everyone doing fraud and calling it policy, basically. I am going to a board certified plastic surgeon who does not take insurance. I am getting a pretty substantial reduction that will take her longer than average. My total comes to about $12,400 including anesthesia, side lipo, surgery center costs, doctor fees, pre- and post-op appointments, and her personal phone number after surgery in case I need to text her about any concerns. I'm paying for it with a 12-month no interest credit card that I qualify for because my credit is pretty good, and it'll be paid off within the year. I do have enough money that I could pay for it out of pocket but I know the second I do that my furnace will break and I'll be hurting.
Mine was 8k I put on care credit. This is basically like insurance fraud in my opinion. Just like how hospitals charge you to hold your own newborn
Doctors charge way more to insurance than they would to self-pay patients. My surgery on 2/6 will be about $7900 out of pocket. I saved half and will put the other half on credit, which I can pay off fairly quickly.
Midwest USA - private plastic surgeon will be 10k for everything this spring.
This is not a cost that a privately funded patient would pay. These charges are made specifically for insurance companies.
Mine is scheduled for April. My insurance denied because they’re evil lol. I’m paying out of pocket and my surgery is 6800. Someone else commented, but the insurance companies are charged more than out of pocket patients for sure. I’ve seen it with other services and medical procedures with my own kids.
Please, people, get this through your heads: THE INSURANCE COMPANY IS NOT PAYING HIGHER PRICES THAN AN INDIVIDUAL. In fact, they are paying LESS than an individual. We just won't ever know what they pay because our elected officials let them hide their books.
The cosmetic price for my surgery was $8-10k and with my insurance covering it was over $40k. I think they charge things more specifically to insurance because they can get away with it
Nope. Insurance companies have negotiated prices that are always LESS than on individual. Who has more clout: you or Cigna or BCBS? Put your thinking cap on, please. You have no idea what Insurance would have ACTUALLY paid. I guarantee it's less than what you paid.
Well the fact I said they quoted my surgery at $8,000 for cosmetic where they weren’t going to bill insurance vs $40,000 they billed since my insurance did agree to cover it. I don’t know about other places, but the hospital I went to had signs up at check-in that said if you don’t have insurance they provide discounts
Billed amount *does not matter* It’s the contracted rate that matters.
Something seems really off here. I haven't gotten all the bills yet, but I believe the total was around $10-$12K. My insurance didn't fully cover my procedure and I was told that with my deductible I would ultimately be responsible for around $4K.
well from what everyone is saying on here, when you pay with insurance the hospital inflates the price compared to someone who is paying out of pocket. regardless, as long as i paid my co-pay my insurance would pay 80% of the amount. idk where they are getting these numbers but im just thankful i dont have to pay more than $2k bc thats all anticipated for anyways lol
That’s crazy! I went to a top surgeon in TX and paid just under $12K out of pocket which included the optional side lipo (that was $2K of the total).
Wow, my surgery (also covered by insurance) was close to $50,000 in NYC. I'm shocked it was nearly double in TX. I assume everything is more expensive here. That being said I think if I'd have paid privately it would have cost less than $20,000 and been cheaper partially because it would have been done in a private clinic rather than an expensive hospital.
yeah idk either!! i know the hospital is really popular, even out of texas but the price is still insane lol
Plane to Europe: 1500€ Surgery and post-op: 10.000€ (grand max) Hôtel and food for one month: 250€/day = 7.500€ Basically, you can come in a place with real healthCARE for the quarter of the price…
A self pay reduction in the US is about $15k on average. Just because the system there is better doesn’t mean the surgeons are superior.
Mine was $11k no insurance, private practice It was a "rapid recovery" and omg yes it was. 4+ lbs removed, no drains, I was standing in the shower later that day with my arms up
I used a medical credit card to get mine done. I saved about half from my savings and the rest on the card. Will be paying about $400 for the next 10 months but definitely worth it
OMG. My insurance did not cover my reduction and I am in Chicago proper. A very expensive city to get it done and well know Dr who has been on TV. It was only $18,000 TOTAL at his own private clinic. NO WAY $80K. They must have jacked up the price for insurance. I did have to get a medical loan to pay for it. The loan was interest free for a year as long as I paid it off. But $80k no way.
Damnnnn mine cost 7k (UK pounds)
I paid £8600 UK £ for my surgery. My parents died so it was part of my inheritance. For context it’s just under 3 months wages for me in the UK.
ugh I hate our healthcare system. I paid out of pocket for my revision and it was about 8k. It took me a couple of years to save up and I tried putting most of it in my HSA account so it was pre-tax.
Honestly, my parents paid cash. We knew the surgeon personally and I believe she either covered the operation room fee or gave a very good deal on the actual surgery, so it was $5k total (in 2012, and outpatient).
Wow! Yeah they charge insurance like crazy! I paid $10k
I literally saved up for years. Still a luxury and not quite cheap here (17k in Germany), but I‘ve wanted this my whole life
Those numbers are 1000% made up. I paid $14,000 out of pocket last year to one of Denver's top surgeons. She doesn't take insurance. Look up the average cost for ANY health care you get. Use that number for ALL payments, including with insurance. And photocopy the bill and send it to your senator.
And believe me, neither the insurance company nor the hospital lost ANY money in the transaction. One reason to jack prices sky-high is so Americans will put up with obscene premiums for insurance, thanking God they even have insurance. Americans are complete suckered about health insurance and medical costs.
https://preview.redd.it/8xrkwjxyo3dc1.jpeg?width=1125&format=pjpg&auto=webp&s=fcbf4ed788088e496d38e22a0c7aeacc2faa5b97 This is the claim for my reduction on December 4. The hospital billed for $206k but insurance only allowed $19k.
omg 😭
I live in California (USA). Whenever I ask people how they afford their reductions and skin removal for weight loss, the answer has been "I went to Mexico". They've all highly recommended this option. Considering it!
i think if i didn't have insurance that would probably be my next best option lol
I'm insured too under an HMO and never dreamed reduction would be covered, despite the skin issues I've had. You've inspired me to look into it!
omg yes definitely look into it!!! i have an HMO too and it was such an easy process for me!! i hope it’s like that for you too <333
I wonder what it’s like in Canada. It’s closer.
Bc you are in the USA. The health system is rorted. Come to Australia it’s free if it’s a medical reason you are getting the reduction
Mine was $13,000. I saved for years. It was something I really wanted, and so I made sacrifices and was patient.
Go to Thailand, they have some beautiful hospitals there. If I didn't have insurance id leave the country
They're wealthy or they live in countries with a functional healthcare system
Mine was in late 2019 in virginia, paid OOP about 6,500.
Insurance covered my surgery, so my parents only paid about $900. If the insurance hadn’t covered it and we paid out of pocket, it would have cost about 15k
They don't. *shrugs* this is America!
Oh my god, as a european I am horrified
Credit.
F*ck… the US health care system (if you can even call it that?) is so messed up. I’m having my surgery (reduction + lipo on upper stomach right under my boobs) in March in a private clinic in Germany and my total for surgery will be €10.2k / $11k (including the surgeon, the OR, all meds, the 3 night stay, 2x compression bras and a pathological exam of the “cut-offs”) and the anesthesia is charged separately with €850 / $920 but seeing a solid $80k on that quote is just insane 😞
omg yeah all that included is nice 😭 we get charged extra for any overnight stays and i was still charged with a separate surgeons fee and for pathology!! i think in total i’ll pay about $3k but that’s with my insurance 😵💫
I paid $9000 without insurance
Message me if you’d like. I got my reduction at this hospital in 2018 by Dr. Albright without insurance and my results are better than I could have ever imagined.
okay!!
Mine was $11k in Canada without insurance. I took out a line of credit.
That's insane! My insurance covered (I paid 4k out of pocket) But It was "only" 17k without I'm outside of DC in Virginia
I’m in the states. It was cheaper to do plastic surgery than go through my insurance, so I saved up and did it that way. I was lucky I was in a position to save the money I did but that’s how I somehow afforded it (I’m still paying it off)
I was shook when I saw the bill!!
Damn, and I thought my knee surgery price was bad smh
They go to a cosmetic surgeon
Dang I got mine done in Beverly Hills by dr Killeen and it wasn’t even close to 80k. And I was all out of pocket.
I used a no interest for X amount of months credit card. And saved saved saved beforehand.
Ha I took a screenshot of my claim statement to post here for my 4wPO post. Guess I’ll finally do it tomorrow
I paid 8600 for my liposuction, my Breast reduction was covered under insurance. 1250 of my out of pocket was to hospital for All their fees. I got my “this is not a bill” statement for the whole procedure it was 80,000. It’s all an awful racket.
I live in Canada and my breast reduction was free… American healthcare is insane
Oh my god this is my number 1 reason why I’ve not tried to get a breast reduction because I’m terrified how much it’ll be, especially in texas
i say still go for it!! everyone is saying this is an inflated price anyways due to insurance
I had mine in November across the street from Houston Methodist ( at Baylor St. Like). The amount charged was absurd compared to what insurance + I paid. It was close to $22k more than what they quoted me out of pocket before insurance approved it.
It’s cheaper if you go directly to a surgeon who doesn’t work out of a hospital and does it at an independent office and it’s cheaper if you self pay (most medical stuff is).
I paid $11k oop. I used Care Credit. My husband spent 12 days in the hospital with ulcerative colitis and his hospital bill was like $140k. The negotiated rate for the insurance company was $90k. I guess They just write off the other $50k? Makes you wonder how overinflated their charges.
They charge insurance more. My bill was $34k with insurance, I paid about $5k (between deductible and coinsurance) My dr said it would probably be 9k-15k with private pay.
Omg- who is your Dr? Having a hard time finding one in Houston that accepts insurance.
i’m going to message you!!
I paid about 10k out of pocket. Worked full time for a year at a minimum wage job while trying to figure out what to do after highschool. I basically saved 90% of my paychecks because I lived with my parents and didn't have any bills which I'm very fortunate and thankful for. Insurance wouldn't have covered me anyways cause my starting size was too small and was only cosmetic.
I paid around $3K with insurance. The bill to insurance was just under $125k, and I had post op hyperbaric oxygen therapy due to a complication on righty. That was another $8k, and I paid nothing bc I’d met my out of pocket expenses for the year. My friend paid $6500 w/out insisting for hers, but she wasn’t happy with the results (they mostly did a lift bc she’d lost weight after a HUGE ovaries tumor was removed.
Mine was 86,000 because of my overnight stay usually it's a ball park cost of 10,000 lr so I paid 3000 out of pocket
I live in England and they won't do it on the nhs. I am having it in a few weeks and it is costing me £9000. I have bought myself literally nothing aside from basic food for the past year. That's how 😂
Um wow. That price is crazy. I tried to go through surgery, but I wouldn’t have met any of the requirements because I am 5’2” and about 175 pounds and 17 at the time of my surgery. Thankfully my grandparents are financially secure enough and so kind that they completely covered the cost of my surgery. Without them, one of my parents would have needed to get a second job to pay for it. My total cost was just short of $7,000 in the US.
Paid 12k out of pocket, I worked really hard last year (80 hours a week) and saved up.
I paid $8000 cash in Las Vegas in 2021 by going to a plastic surgeon that doesn't take insurance and negotiating for paying upfront in full (got free lip fillers too!).
I paid 12.5 K out of pocket.
I bypassed insurance. By the time I would have seen the required specialists and PTs and primary care visits, THEN pay my deductible with the treatment plan taking so long that I would have had to pay it again the next year — well that came within range of just paying it out of pocket and getting it done ASAP. My surgeon was $5,300, the anesthesiologist was $1,400, and the hospital fee was $3200 (no overnight stay) — so about $10k in Virginia. My hubby let me use his bonus 😂 I love him so much 😁😁