I am looking over the bills I've received for my PAO. I thought you'd all be amused and/or appalled by some of these numbers. Note that I have not yet received a bill from the surgeon yet!
These numbers all represent pretend money in many ways. For example, I pay 20% co-pays on pretty much everything, but my "out of pocket maximum" is $1,500 per year, meaning that most covered, in-network charges I incur over $1,500 are paid by Aetna. I also have to pay a $350 deductible. Prescriptions have their own deductible. And, if I go "out of network," there are additional maximums and deductibles. All of my care to date has been "in network" with a few things just not covered by insurance at all, such as $600 for autologous and directed blood donations.
So far I've actually paid about $2,000 for out of pocket maximum, medical deductibles, and prescription deductibles. I have also paid about $3,200 for non-insured but necessary expenses that I would not have incurred without having a PAO (blood donations, assistive devices, vitamins, pool membership, hotel in Tacoma for family members, gas to and from Tacoma, meals in Tacoma.)
The total hospital bill (5 night stay in a private room which was billed as "semi-private" and a huge list of undisclosed "incidentals") is a whopping $109,000. The negotiated rate that Aetna paid is just over $30,000. The hospital had to make some margin of profit on the deal just to stay in business. That leads me to ask, what was the true cost? Had I paid this out of pocket with my 50% cash discount the hospital would have realized an additional $25,000 profit over what Aetna paid. Luckily I did NOT have to pay out of pocket, and really, how many people would have actually paid a bill like that despite signing a payment guarantee? I was prepared to pay if necessary but I realize most people could not afford to.
In addition to the hospital bill, the charge for the anesthesiologist was in the neighborhood of $3,000 (my cost = zero since insurance covered in full). Prescriptions were billed out at about $600; my co-pay was just under $200 ($150 of that just for Fragmin which is considered by my insurance plan to be a "specialized" drug). A huge supply of narcotics only cost me $20; that's a bargain considering what each pill sells for down at the bus mall on 82nd Street. Medical equipment was billed at $600 but this does not include the CPM machine since I have not yet seen that bill (my cost for equipment will be zero because insurance will cover it all). Various x-rays and lab tests were billed at a couple hundred dollars (again, my cost = zero).
I will probably go out of network for physical therapy (see my prior post), which means I'll be paying for much of that out of pocket, about $50 per visit. Aetna may add my PT to their network but I'm not holding my breath.
The bills keep rolling in. I'll publish a grand total in a future post.