Appx. Cost & Lifting/Other Precautions

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Appx. Cost & Lifting/Other Precautions

Postby Manitourose » 16 Jun 2014, 15:20

Hello again,

I know everyone's situation is different but I thought I'd ask some additional questions. Perhaps someone else pondering may get a benefit from reading anyone's answers. I have contacted my surgeon's office regarding these (and my Health Insurance) but its been days waiting and follow up calls. If I proceed with surgery it is this Thursday.

1) If you are in the USA, any approx. cost with health insurance for a simple fistulotomy? I know everyone's situations different and insurances, but I can't find anything! Waiting (not so patiently anymore) to hear back from the office. That is only if you feel you want to disclose. I'm on a private insurance plan (since I am a grad student) with a deductible of 1,500k and then it goes to 80/20. Though they get you on the little tid-bits, like only paying "part" of a urinalysis when I had a UTI from the analpram cream I was previously given by another CRS. It makes getting to the deductible tricky.

2) Anyone have lifting/bending or any other unique precautions post simple fistulotomy and if so for how long? Again, waiting on this answer. The nurse seems to think there will not be any and they are aware I am under a serious time constraint since I am supposed to start my own clinical rotations for a health field in another state on June 30th.

Thanks everyone and I know everyone's story is unique so I can't base a lot off of the responses. Just another vent because I am so nervous.
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Re: Appx. Cost & Lifting/Other Precautions

Postby Jbl22424 » 16 Jun 2014, 15:29

Can't speak to a fistulotomy but for reference, my LIS surgery was $6,200 in CA (Sutter). Physicians fee was only $500 perhaps because it is such a quick procedure? The OR and anesthesia were the rest of the cost. I paid about $1K. I have an 80/20 plan and I think I hit my deductible a while ago.
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Re: Appx. Cost & Lifting/Other Precautions

Postby Manitourose » 16 Jun 2014, 16:12

I haven't figured out the "thanks" thing on here yet. But thank you!
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Re: Appx. Cost & Lifting/Other Precautions

Postby Cap2 » 18 Jun 2014, 14:51

Hi there,

I am a newbie here. My fistula surgery is scheduled for next week. I was able to call the surgery center (outpatient) and speak to a billing person. She was able to give a rough estimate. I have met my deductible for the year ($800.00). I am on a PPO plan. My out of pocket is $4,000. I was told the surgical charge for the surgery center was $1072.00. The anesthesia and CR surgeon costs were not included in that. I have another $2,300 to hit my out of pocket before 100% is paid. She explained that if it were to be more than $2,300 I would not be paying insurance would. I was made to believe that the total costs were close to that amount. That wasn't including pathology if it was needed. Most cases it would not be needed. I hope that helps. You should be able to get your possible CPT codes and diagnostic codes from your surgeon. Then you can call the insurance company, your Surgical Center, Anesthesia group, and CR surgeon to help get estimated costs. It is amazing that there is an expectation that you have to go blindly into these procures not being able to prep yourself financially. Hope everything goes well with your surgery and recovery.

Best of luck : )
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Re: Appx. Cost & Lifting/Other Precautions

Postby Manitourose » 18 Jun 2014, 18:33

Absolutely about what you said going in blindly. Called the office and they said the contracted rate for the procedure was between 1,300 and 2,600. Checked cpt code for this and it ranged that give or take the regional location, contracted rates so on. Aware of the other costs as you mentioned. Got a call from the hospital today who said the cpt code of 46270 which is fistulotomy us 8k!!! Something is strange but by no means do I expect it to be cheap. Typing on my phone as we are on our way to Chicago for the surgery tomorrow. Thanks so much and welcome. Will keep you updated. Best wishes!!
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