My surgery/hospital cost breakdown for the curious

[istytehcrawk 256]

The last pending insurance claim for my surgery/hospital stay processed today, so I thought I'd give the cost breakdown for anyone who is interested.

Context: I live in Illinois and had my surgery at Barnes-Jewish Hospital in St. Louis, Mo., through the Washington University WLS program. My primary surgeon was Dr. Arghavan Salles, though Dr. Christopher Eagon assisted. My surgery was on Feb. 15, and I went home on the afternoon of Feb. 17. My insurance is the Health Alliance POS 6300 Elite Silver CS plan, purchased through the Illinois Health Marketplace. I have a $1,000 deductible.

Laparscopic gastric bypass w/ Roux-en-Y: Billed = $5,100, My cost = $145.97 (I believe this is for Dr. Salles)
Laparscopic gastric bypass w/ Roux-en-Y: Billed = $2,550, My cost = $29.19 (I believe this is for Dr. Eagon)
Anesthesia gastric restrictive for morbid obesity: Billed = $3,360.00, My cost - $1,013.22 (includes $1,000 deductible)
Anesthesia gastric restrictive for morbid obesity: Billed = $3,360.00, My cost - $63.22 (not sure why there are two anesthesia charges)
Contrast X-ray - Esophagus: Billed = $123, My cost =$0

Each of the above were individual claims. Then there's the big one, for the hospital stay, which breaks out as follows:

Room-board/semi: $2,210.00
Pharmacy: $439.90
Med-sur supplies: $10,306.95
Sterile supply: $472.50
Laboratory OR (Lab): $35.00
Lab/Chemistry: $244.00
Lab/Hematology: $81.00
DX X-ray: $448.00
OR services: $23,365.00
Anesthesia: $8,336.00
Occup Therp/Eval: $259.00
Drugs/detail code: $698.15
Drugs/self-admin: $8.00
Recovery room: $2,460.00
Educ/training: $110.00
O.R. procedures for obesity W/O.CC/MCC: $0.00
TOTAL billed = $49,473.50, My cost = $100.00

All told, I only have to pay $1,351.60 out of $63,966.50, or roughly 2.11 percent of the overall cost, and my portion includes the $1,000 deductible. Without that, I'd only be responsible for $351.60, or 0.55 percent of the overall cost.

[Danny Paul 761]

My total out of pocket cost was a $300.00 co-pay. Which I couldn't get my secondary insurance to cover.

[tanyamann32 84]

My total out of pocket cost was 0.


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[kara2010 0]

Did anyone have to pay the hospital a portion upfront?

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[Bellasoo 45]

I am going through the same doctors as you are. My insurance changed on 5/1 and I am now waiting for insurance approval. I now have a $2500 out of pocket max but I have a 10% surgical co-pay that I have to pay on top of the OPM. I'm afraid of what I will have to pay.

[browneyez42 280]

My out of pocket cost was $1,150 and total chat for gastric sleeve was $26,574

HW: 256
SW: 238(4/25/18)
CW: 224
GW: 165

[Frustr8 7,886]

Doesn't all this give you a Migraine? Its not my bill, but thinking of it all,Geesh! No wonder the insurance companies make such a profit, they charge high,⬆ pay low⬇. Dang their money grabbing hides.😝

[tanyamann32 84]

My total cost was 0 in Israel .

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[Frustr8 7,886]

Mazel Tov Tanyamann32. Bariatric wise,definitely the Promised Land!😎

[KatallacStrong 49]

I’m in St. Louis too, but I’m going down to Festus (Mercy-Jefferson) because my insurance covers it at 90% (opposed to its standard 80%) because that facility is considered a BCBS “Center if Excellence”. I am curious what my OOP will be at that coverage; my consult is in early July but I already have 4 of the 6 consecutive appointments and the psych apt done so fingers crossed that helps lol!