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      TOPIC: who is who?

      Re:who is who? 5 years, 9 months ago #21638

      Hi, I'm John from Portland, SLAP tear but I had an 80% thickness RC tear that was repaired with 2 anchors + SAD. I'm almost 4 weeks out and feeling very good. My doctor has not put me in PT yet (he just has me doing my own Passive PT exercises). I'm 47 and a 4.0 tennis player.

      I'm just starting to get the Medical bills on this procedure and I don't see many people comparing notes on this. I believe my procedure (including MRI) is going to end up costing me about 5K out of pocket.

      Re:who is who? 5 years, 9 months ago #21640

      • riderk
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      That is all up to your insurance coverage.

      Re:who is who? 5 years, 9 months ago #21642

      • RedOwl
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      My surgery plus PT will end up costing me around $5K as well. I actually think that's a pretty good deal, all things considered.
      SLAP tear repair and biceps tenodesis 3/2/2011

      Re:who is who? 5 years, 9 months ago #21646

      • Tri Di
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      Hi - someone asked me about this the other day, and I dug out this info that I posted ~Oct 2009. The short answer is probably $4000+, not including the cost of initial x-rays and ER treatment when I got hurt, visits to a Sports Med Dr while trying to recover w/o surgery, and more PT over the last few years when some issues flared up. One suggestion - get info about PT coverage in writing before you start!

      The very detailed answer:

      I had a slap 2 tear, detached biceps tendon, and some damage to the AC joint all repaired arthroscopically. I'm in the Houston area and used a physician who is the team doctor for some of our pro sports teams.

      I actually added this up one day just out of curiosity. I have no idea how the insurance industry and medical profession work on billing, it was bizarre sometimes how much they charged and then how much the insurance company allowed. My totals for the surgery (MRI, surgery facility, Dr and Asst fees for the surgery, initial and post-op visits, and x-rays at one post-op visit) were:

      Billed by the various entities: $48,000
      Insurance "allowed": $27,000
      Insurance paid: $16,400
      Amount I was initially billed: $10,840
      Surgery facility write-off (something to do with billing in network even though they were technically out of network) - a credit to me for $10,250
      Amount I paid: $950

      There were also a few bills that came in late for some of the radiology stuff, probably another $100-200 or so.

      I had a rough recovery with a ton of PT, which was my biggest expense (~30 visits prior to surgery - $500 deductible + $50-60 per visit) and 30 visits after with a PT near my home (no deductible, $15/visit + a few at full price after my insurance ran out), probably a total of ~$2500-3000. Again, the billing was flaky -- there is a HUGE difference in how my insurance handled PT services that "bill as a facility" and those that "bill as a doctor's office" -- in my case, the first scenario had me paying a deductible plus 20% of the full charges, so after the deductible, I paid $50-60 per visit. In the second scenario, however, the insurance negotiated rate was $60 per visit and I paid $15, with no deductible. I'm sure this varies with different facilities and insurers -- it even varied within my own insurance company, as most of my claims were processed incorrectly and almost a year later are still not straightened out. I was allowed 30 sessions and used them all. My Dr wrote an appeal for more, but it was denied (medical decisions by some insurance employee -- don't get me started on that!), but my PT was great about being available for questions and let me work out at his facility.

      I didn't track my meds, but that's something else to add to your list.

      Re:who is who? 5 years, 9 months ago #21647

      • Cavitator
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      Total cost for my 5 anchor SLAP repair, Bankart repair, capsular shift, SAD and chondroplasty (with complications of permanent brachial plexus damage and RSD), 21 months of PT (3 months pre-op), 15 stellate ganglion blocks and 3 cervical epidurals post-op: ~$310,000 so far and rising with loss of income from permanent disability (+/- $100k/yr) x another 15 years = who knows? So....who cares what insurance paid at this point!

      But I'm not bitter
      3/51 Bilateral VIII C.N. complete neurectomy
      2/60 Failed Supratentorial electrotherapy w/subsequent pancerebral resection
      2/89 Bilateral aqueous humor drainage w/complete retinectomy
      3/02 Quadralateral proximal extremity resection from gestational thalidomide exposure

      Re:who is who? 5 years, 9 months ago #21648

      • riderk
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      I did add it up once, but that will have to be revised soon. Around $140,000 billed for the 3 surgeries. Then there is 2 years of meds. The one I find hard to believe is the lidocaine. You get 3 pads in a box - the script calls for 3 a day, but I use one or two. $350/box. After insurance, for a month, ambien is $2.19, percocet (60) is $5, oxycontin (60) is $25. Celebrex, which does nothing for the shoulder, but does help my neck, is $25. When I went to the first facility, I had to pay $12 for parking per visit (every month for over a year). At least the new one is in the burbs, close with free parking.

      Then there is the pain management doctor, and all the visits (every month) and testing he does.

      And PT, which I can do myself as I know it all at this point - LOL - yes, I am being sarcastic.

      With everything together, it was $1750 out of pocket per year, $30 copay every time I visited the doc after the 3 month post op limit. Probably $5000/year for 2 years.

      Gosh I hope I am done with it ALL in 3 weeks!!!! I know I should not get my hopes up, but this is the first time I do not feel in total despair.
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