Hospital Cost Conundrum

[droplyfe]

Not sure if this is the right section, but it's definitely not 'aesthetics'

I received a quote from a well-known surgeon for double jaw surgery and a few other things to the midface/chin, which was overall a lot better than what I was expecting. Everything on their end seems great so far and I like the clinic. I am 100% ready to pay the surgeon’s reasonable fees.

The issue is that he works in a major hospital and I would need to stay multiple days along with having a long operation, however I have no clue how much this will cost or if it will be covered by insurance (I am on my parents' PPO plan). In the case that the hospital fees won’t bankrupt me, I would move forward immediately and set the date for next year, but paying a full 100k+ cost for the multiple day hospital stay would make this obviously unaffordable. 

I’ve posted my scans and plans on the forum previously, but it’s a typical case (vertical maxillary hyperplasia, maxillary hypoplasia, mandibular hypoplasia, microgenia, infraorbital hypoplasia, maxillary and mandibular asymmetry, etc). I do not have obstructive sleep apnea nor TMJ degeneration. The issues stated were nasal airway obstruction, hypertrophied turbinates, deviated septum, lip incompetence, and mentalis strain.

Since this isn’t a “required” surgery, how do I figure out how much my hospital fees will cost? If anyone has experience related to this, it would be very helpful to hear. I can post more details or specifics if you’d like (like insurance, diagnoses, plans, etc).

[kavan]

Not sure if this is the right section, but it's definitely not 'aesthetics'

I received a quote from a well-known surgeon for double jaw surgery and a few other things to the midface/chin, which was overall a lot better than what I was expecting. Everything on their end seems great so far and I like the clinic. I am 100% ready to pay the surgeon’s reasonable fees.

The issue is that he works in a major hospital and I would need to stay multiple days along with having a long operation, however I have no clue how much this will cost or if it will be covered by insurance (I am on my parents' PPO plan). In the case that the hospital fees won’t bankrupt me, I would move forward immediately and set the date for next year, but paying a full 100k+ cost for the multiple day hospital stay would make this obviously unaffordable. 

I’ve posted my scans and plans on the forum previously, but it’s a typical case (vertical maxillary hyperplasia, maxillary hypoplasia, mandibular hypoplasia, microgenia, infraorbital hypoplasia, maxillary and mandibular asymmetry, etc). I do not have obstructive sleep apnea nor TMJ degeneration. The issues stated were nasal airway obstruction, hypertrophied turbinates, deviated septum, lip incompetence, and mentalis strain.

Since this isn’t a “required” surgery, how do I figure out how much my hospital fees will cost? If anyone has experience related to this, it would be very helpful to hear. I can post more details or specifics if you’d like (like insurance, diagnoses, plans, etc).

The conundrum to me would be WHY the surgeon did not give you an estimate of what the hospital fees could be. Clearly, he would know more about 'how to figure out'  or estimate this more than folks on here could.  He knows the NAME of the hospital because he does surgery there. We don't. This is something you should PRESS him on.

[droplyfe]

The conundrum to me would be WHY the surgeon did not give you an estimate of what the hospital fees could be. Clearly, he would know more about 'how to figure out'  or estimate this more than folks on here could.  He knows the NAME of the hospital because he does surgery there. We don't. This is something you should PRESS him on.

My bad, I wasn't really giving all the info in the post bc I wanted to see if anyone else had been through a similar scenario.

I did talk to their office, who said that my insurance plan(will be blue cross ppo) would take care of most hospital and anesthesia related costs, meaning that I'd only pay the surgeon's costs. This would obviously be great news, but when talking to an insurance rep, they seem to only be involved after the case has been reviewed and medical issues deem the procedure necessary. I don't know if I can trust that everything would go through seamlessly. The hospital is in-network.

More so my question is if anyone has had insurance cover [most of] hospital costs for a case without obstructive sleep or a large malocclusion? I know this is smth that's probably case by case and this forum can't really give input into such a specific thing, but just looking for peace of mind with other's experiences. 

[GJ]

Agree with Kavan the best source for a direct answer will be the surgeon or the surgeon's front desk. They should be able to answer all this with a five minute phone call.

In general, major insurance companies don't cover the surgery unless it's for apnea or the bite.

[droplyfe]

Agree with Kavan the best source for a direct answer will be the surgeon or the surgeon's front desk. They should be able to answer all this with a five minute phone call.

In general, major insurance companies don't cover the surgery unless it's for apnea or the bite.

Yep true, I did talk to them but left more confused than informed.

Covering the actual surgery is not an issue for me at all and the price is very reasonable, its the hospital costs for the 3 day stay that could be ridiculous amounts. From the people you've seen over the years, do you know if it makes sense for insurance to cover most of the in network hospital costs for a non-"required" surgery?  This is what was told to me by the front desk but I'm just looking for a 3rd party experience to give peace of mind before getting into ortho.

[GJ]

Yep true, I did talk to them but left more confused than informed.

Covering the actual surgery is not an issue for me at all and the price is very reasonable, its the hospital costs for the 3 day stay that could be ridiculous amounts. From the people you've seen over the years, do you know if it makes sense for insurance to cover most of the in network hospital costs for a non-"required" surgery?  This is what was told to me by the front desk but I'm just looking for a 3rd party experience to give peace of mind before getting into ortho.

I think insurance usually covers hospital so long as the surgery was approved for a medical reason (i.e. something insurance covers).
But, this likely is a case by case thing. There are hundreds of insurance companies, and each hospital might have a different arrangement with them.
Just tell them you need clarification, and I'd get it in writing...

[thedude]

The hospital charges have been by far the most frustrating part for me. It's a complete racket. The list price at almost all hospitals for this procedure is around $150,000 and as far as I can gather the actual amount insurance companies pay out is around 10k. So it's a 1,500% markup. That should absolutely be illegal.

The best two options I came up with if I could not get the procedure covered by insurance were to either go with Dr. Gunson who has a deal with his hospital for out of pocket costs of around $15,000 or to go overseas to a country that does not have a corrupt medical system like the US. Alfaro in Spain seemed like the best option if it came to that.

[kavan]

The hospital charges have been by far the most frustrating part for me. It's a complete racket. The list price at almost all hospitals for this procedure is around $150,000 and as far as I can gather the actual amount insurance companies pay out is around 10k. So it's a 1,500% markup. That should absolutely be illegal.

The best two options I came up with if I could not get the procedure covered by insurance were to either go with Dr. Gunson who has a deal with his hospital for out of pocket costs of around $15,000 or to go overseas to a country that does not have a corrupt medical system like the US. Alfaro in Spain seemed like the best option if it came to that.

I remember I told you (elsewhere) to break up the surgeries. Like one of them, under eye area (I think) can be done in non hospital setting and/or doesn't need hospitalization. It didn't when the first person on here who got that got it some time back. The bimax usually does though. But the bimax, since it can be assessed as FUNCTIONAL as for the bite part of it and not 'just for aesthetics'  might have a better chance of the hospitalization being paid for. I don't know for sure though. So, if this is something where your surgical fees were for all to be done together where the hospitalization would be for recovery from all of them. If that's the case, insurance would see a procedure in the whole surgery package as a non functional one.