Cost of gallbladder surgery
August 16, 2015 8:55 AM   Subscribe

I have a college insurance that pays 60 percent of my gallbladder surgery. How much did you have to pay for such a procedure? I am scared I will owe 20k or so by the end of this. Any thoughts?
posted by barexamfreak to Health & Fitness (25 answers total)
 
I can't help you pin down the price, but your plan likely has a maximum annual out-of-pocket limit that you will hit. Regardless, do you really have a choice?
posted by jon1270 at 9:01 AM on August 16, 2015


Response by poster: Well yeah I have a maximum out of pocket of 6 thousand so I guess that helps me.
posted by barexamfreak at 9:03 AM on August 16, 2015


Mine ended up around $45000 when all was said and done, but that included an ER visit and three days in the hospital. If it's scheduled and outpatient surgery, I would assume the cost would be lower. This was in New York.
posted by jaksemas at 9:14 AM on August 16, 2015


Also, it will probably be based on allowable or contracted fees, which are often deeply discounted from "list." The hospital should be able to tell you - just make sure you account for the various charges that won't flow through the hospital. The anesthesiologist and the surgeon will likely charge you separately for their services.
posted by COD at 9:15 AM on August 16, 2015 [1 favorite]


Also, my insurance provider offers a cost estimate service. You might poke around on your insurance website to see if they offer one, or call member services and see if they can help you estimate the charges.
posted by jaksemas at 9:15 AM on August 16, 2015


Plan on paying the 6k.

Just to give you a data point, my gallbladder removal was over 80k before insurance. Yours probably won't be quite that much since mine was emergency and I also had ERCP to remove gallstones in the bile duct
posted by tealcake at 9:15 AM on August 16, 2015 [5 favorites]


Looking at old bills, and looking at the non-bullshit charges after the insurance company writedowns, it appears that my wife's outpatient lap-choly a few years ago in NY ran about $5K for the surgeon and hospital + anaesthesiologist + drugs and whatnot, but obvs I could be missing some nontrivial bill. The charges before the writedown were more like $15-20K. Presumably the charges would have been higher if they'd had to convert to an open cholecystectomy.

On preview: that's not including an overnight stay and ERCP that precipitated the choly.
posted by ROU_Xenophobe at 9:21 AM on August 16, 2015


My wife had laparoscopic gallbladder surgery a few years ago and the bottom line on the bill was about $30k. But I never really understand how those totals shown on insurance statements line up with the real bill someone would get if they were actually paying it themselves. Our insurance covered virtually all of it.
posted by primethyme at 9:31 AM on August 16, 2015


I'm right there with primethyme: all told, services for laparoscopic was just under $30k (consultation, ultrasound, blood work, surgery, pathology - the works) and insurance paid almost all of it.
posted by komara at 9:42 AM on August 16, 2015


Response by poster: Do you think that my husband and I can get individual medical insurances so that we do not have double annual out of pocket maximums?
posted by barexamfreak at 10:17 AM on August 16, 2015


Yeah mine was $20K to $30K before insurance and I paid around $3K in total out of pocket. If you know where you'll have it, you should be able to get an estimate from the hospital. In addition, hospital billing departments are usually very good at doing payment plans and working with you. Keep in mind too, that you generally receive a few different bills so you may have to juggle a few different payment plans. (I had one for the hospital, one for the surgeon, and one for the anesthesia.)
posted by Crystalinne at 10:24 AM on August 16, 2015


My husband and I (and kids) are on the same insurance plan, and there is an out-of-pocket maximum for the individual and for the family (e.g., something like OOP max of $6000 per person or $11000 for the family). I don't see how you being on individual plans would make things better, but it depends on the details of your plans. Also, you've probably missed the open enrollment deadline for this year.
posted by leahwrenn at 10:27 AM on August 16, 2015


Mine involved the ER and three days in the hospital (so 4 nights) and was about $35K. This was in 2007.
posted by jgirl at 10:28 AM on August 16, 2015


Response by poster: Well would t you have to pay the family annual out of pocket even if only one person goes to the doctor? It says the individual out of pocket is 6500 so thefamily is 13k out of pocket. That means I will have to pay 13 k just for my surgery potentially even if my husband never uses the doctor?
posted by barexamfreak at 10:32 AM on August 16, 2015


> Do you think that my husband and I can get individual medical insurances so that we do not have double annual out of pocket maximums?

Probably, but it depends enormously on where you are. Assuming you're in the US - which, based on the lingo you use, you are - google [your state + insurance exchange]. There will probably be some sort of cost calculator. For a very general ballpark-y sort of thing, you can use this one that is put together by the place where I work. But yeah, you'll have to wait for the next open enrollment period.
posted by rtha at 10:32 AM on August 16, 2015


Well would t you have to pay the family annual out of pocket even if only one person goes to the doctor? It says the individual out of pocket is 6500 so thefamily is 13k out of pocket. That means I will have to pay 13 k just for my surgery potentially even if my husband never uses the doctor?

We can guess about this or you can call your insurance company and ask them. Obviously they will have far more correct information than we have.
posted by The Michael The at 10:49 AM on August 16, 2015 [2 favorites]


It says the individual out of pocket is 6500 so thefamily is 13k out of pocket. That means I will have to pay 13 k just for my surgery potentially even if my husband never uses the doctor?

No. If your individual MOOP is 6500 and you have surgery that could potentially cost you over that, then you pay 6500. For example: Your mecical bills cost the insurance compay 100,000. Without the MOOP they would pay 60,000 and you would pay 40,000 (the 60/40 split you mention above). With the MOOP, you pay only the 6500.

BUT if your husband used the doctor, he is has an individual MOOP to-reach/to-protect-him as well.

AND if your hypothetical child has the same usage in the same year, well, you have already met the Family MOOP for the year by using the two individuals and the kid rides free.

TLDR: Each person pays towards his/her individual MOOP. An individual does not go over the the individual MOOP and the family as a whole unit does not go over the family MOOP.

Make sure what the MOOP includes, too. In my plan it does not include outpatient prescriptions. Those have separate copays and there is no upper limit on the cost. Inpatient drugs and clinic administered injections and infusions are covered as part of the MOOPed health insurance, not the prescription plan.
posted by SLC Mom at 10:55 AM on August 16, 2015


Response by poster: Ok so if our family max of pocket is 13k but my individual is only 6500 then all I pay myself is 6500? And not a maximum of 13000?
posted by barexamfreak at 11:00 AM on August 16, 2015


Correct. The family max is for the family, not just am individual.
posted by ThePinkSuperhero at 1:14 PM on August 16, 2015 [1 favorite]


Also, are you sure the family max is double the individual max? Call your insurance to confirm; it's not always Individual Max times Number of People in Family.
posted by ThePinkSuperhero at 1:16 PM on August 16, 2015


Assuming you're in the U.S., one thing to consider for 2016 coverage: if you buy insurance through the Marketplace, you may qualify for a reduction in the out-of-pocket expense. This "cost sharing reduction" benefit applies if you buy a Silver plan, and your family income is between 100 and 250 percent of the federal poverty level. For 2015, the qualifying income range for a family of two is $15,730 to $39,325; it will be a bit higher for 2016.

More info here.
posted by Snerd at 2:25 PM on August 16, 2015


Something to keep in mind: most hospitals are really good about setting up payment plans that don't accrue interest — so call the hospital you plan to have the surgery at and find out if they do that. I had almost $6k accrue last year from many different procedures, surgery, and tests and paid most of it over time with zero late fees/interest. Smaller doctors are different, and have individual payment policies, but the hospitals themselves are usually very flexible.

Also, keep in mind that the procedure might cost $30k, but your insurance has certainly worked out some kind of deal with your medical provider. So the discount comes off the total FIRST, then they pay their 60%, then you pay your 40%. I would plan on the $6500 to be safe, but you might end up surprised and pay a lot less.
posted by clone boulevard at 4:45 PM on August 16, 2015


Mod note: A couple comments deleted. barexamfreak, please stop threadsitting. You've made it clear what you're asking and people are giving what information they can.
posted by LobsterMitten (staff) at 4:56 PM on August 16, 2015


I had emergency gall bladder surgery a few years ago, and the bottom line was around 5K, I fretted a bit and then the hospital called and said "If you pay in full, we'll discount it 40%." So I did.
I've since heard from many friends in the health care industry that what you pay out to the hospital is very negotiable.
So do it - if it ends up being an emergency, it could get more ugly and pricier. Also, the crisis hurts like nothing I've ever felt (childbirth included).
posted by dbmcd at 7:00 PM on August 16, 2015


Also, as long as you're paying something, the hospital typically will not hassle you. I was born quite prematurely, and the family story was that my parents were paying the hospital for my post-natal care at $25/month until I was 12. Or something. The point is

(1) call the insurance company and ask them to explain your plan to you;
(2) the hospital will work out a payment plan for the part of the bill that is your responsibility;
(3) make sure the hospital you're considering is in-network with your insurance, since it sounds like you have a little time to think about this. You can discuss this with your insurance folks. There is a phone number on the back of your insurance card.
posted by leahwrenn at 9:27 PM on August 16, 2015 [1 favorite]


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