Hip Costs

Hip costLast summer, a student at Washington University in St. Louis invented a fictitious, uninsured grandmother who needed a hip replacement. He called more than 100 hospitals to get a price for the procedure.

About half of the hospitals couldn’t provide a price estimate. Among those that did, the quotes ranged from $11,100 to $125,798.

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8 thoughts on “Hip Costs”

  1. How can a hospital give a quote without knowing which insurance company they will be overcharging for the procedure?

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      • To difficult to expect a single price. A single CC (complication) can multiple that price. In hospitals, they use codes known as DRGs. Each DRG has a value associated with it. Then based upon social-economic factors of where the hospital is located, it’s multiplied against this unique number to get a dollar amount. That’s typically what hospitals get reimbursed.

        Most hospitals will knock 40% off the top of what insurance companies are paying for private payers. This reduced amount is pretty close to what Medicare pays.

        Here are some examples of different hip replacement payments.

        DRG 466 – REVISION OF HIP OR KNEE REPLACEMENT W MCC $28,390.02

        467 – REVISION OF HIP OR KNEE REPLACEMENT W CC $18,433.84

        468 – REVISION OF HIP OR KNEE REPLACEMENT W/O CC/MCC $14,779.50

        *** This is NOT a perfect example, but only to show how difficult it is to have a single dollar amount. Any hospital or doctor that comes up with a fixed price is nuts and irresponsible.

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  2. I did miss that part, but the story is the same, just switch insurance for income or net worth. If the patient was worth $20M, why leave money on the table by quoting $11,100?

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  3. The difference might be whether it’s surgery or included post surgery visits/testing- rehabilitation from hip surgery is long and tedious and in most cases requires post-hospital convalescence or a home nurse as well as countless months of physical therapy…

    I had major hip surgery done last year and thank my lucky stars I had phenomenal insurance that covered most everything AND didn’t cut corners on recovery – some companies want to cut off from PT early or don’t feel the follow-up MRI/Xrays are vital.

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  4. My guess is the hospital(s) that would charge $11,100 don’t have emergency rooms–or don’t have emergency rooms that are over-used or abused. (By law, any ER in the US has to treat whomever comes in whether they can pay/have insurance or not. Some hospitals, in order to stay in business, have to charge more in other areas to make up for the losses in the ER).

    The hospitals at the other end (that would charge almost $126,000) are making up for losses in the ER or other departments (maybe liability insurance premiums?).

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  5. Take out the “for profit” aspect of health care, have a single payer insurance system, and then it really doesn’t matter, does it?

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  6. My brother-in-law asked about knee replacement. Since he doesn’t have insurance, he asked the surgeon to quote him a cash price. The surgeon consulted with his partners, this being the group who own this for-profit hospital, and they came back with a quote for surgery, follow-up and physical therapy about 1/3 the price they otherwise charge. Why? It costs a lot to pay a staff whose only duties are to fill out insurance paperwork, make sure the correct medical codes are used, and dun the insurance companies for payment.

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