Knee Price Research - meniscus and ACL Reconstruction

So,  I dont have an ACL any more,  the MRI confirmed it,  I have a tear in my meniscus.

I need surgery.  I have the choice on whether I fix one both or neither,  so I ask Dr. Lewis whether it is cheaper to do both,  he says,   it will probably be almost the same price to do both of them at the same time,   he described that the cost of his time is minimal compared to the other costs.  So.  it is time to do some research.  hopefully someone else finds some use in this information.

I went into to ISMI in boise with DR Lewis who told me I needed the surgery and I connected with Penny Dunlap, RN in their office for some surgery scheduling.  I asked about the procedure codes and costs and she gave me two,   the Meniscus surgeryis 29881  and the ACL Reconstruction is 29888.   She said their is also a discount if you do both of them but she did not give them to me.

• Dr. Lewis ISMI Fee - 29888 - $2875
• Dr. Lewis ISMI Fee - 29881 - $1590

Penny helped me to understand that there are two other fees I have to worry about,  the fee for the facility I would be going to,  as well as the anesthesiologist fee.  She gave me the number for the Treasure Valley Hospital,  where she said the cost is most efficient,  and I can ask them for the cost of the Surgery facility,  and i can also ask them for the contact information from the anesthesiologist so I can get the cost from them.

It takes a couple of days to get a call back from Treasure Valley as it turns out it is done by a single person,  not a department.  (Leslie @ 208.373.5057)  In the mean time I figure I will do some searching at other local facilities to get some perspective on cost.
St Als - Boise
St Als provides their prices right on their website where they list the prices at 

• 29888 - $21316.56
• 29881 - $9450.41

Wow!  that is speedy,  especially compared to the amount that the surgeon would make,  I am imagining that the cost will be significantly lower at Treasure Valley,   but I will wait to hear back,  I needed a bit more,  and since I had done a cost comparison on my MRI and found that the cost of an MRI at the Imagining Center of Idaho was only 575 cash price (compared to something like $1500 out at Treasure Valley imaging)  I decided to also call a surgery center out in Caldwell to find out if there is a significant price difference.   So I called Idaho Surgery Center.  I also left a message for Deb out there,  but this time I left on her voicemail the numbers of my procedures,  and I gave her permission to leave the costs in a voicemail if she was unable to get ahold of me.  We will see who calls back first.

Treasure Valley Hospital
I called again on a third day and left a detailed message about what I was looking for with TV and this time Leslie from TVHospital called me back very quickly.   She confirmed my insurance information after I asked about both a cash price as well as the insurance price.  I told her I was Blue Cross of Idaho and she explained that their deal with BC of I was so good that I would certainly want to use that.  She called me back after 10 minutes or so of research to give me the  pricing details.

• Self Pay for both procedures 29888+29881 is $10450
• Insurance Price for both procedures  29888+29881 is $5562.07

She went on to explain that their policy is require payment of half of the cost upfront for unmet deductibles. so in this case it would be $2900 upfront.  She further went on to describe that if needed we would likely work out a payment plan on the rest for up to a year and then it could go to collections.  In this case it sure seems like the insurance price is better,   even the higher self pay price is  less than half of the cost of St Als (unless St Als also does some discounting for combining procedures)

Leslie then gave me the number for the Anesthesiologist , (800.275.8752 x 2855),  Which was answered quickly by someone saying "Anesthesiologist consultants".  They transferred me to someones voicemail where I told the person a bunch of information about what I was looking for

Anesthesiologist Consultants
So,  anesthesiologists provide a different service and there fore have an additional cost.   Heather from the company called back within a few hours and since I left the information about the procedure codes on the voicemail she was very prepared when she called me and had details of the costs.   I had told her it was 90 minutes of OR time,   and there was to be a femoral and or knee block. (Penny from ISMI told me all of this).  Heather told me that for 90 minutes of time the self pay cost is $935,  and the Blue Cross of Idaho rate  is $610 dollar.

• Self Pay $935
• Insurance Price $610

It seemed to me that the cost was a little bit low so I asked if that included the drugs in the case that I had a Femoral Block or Knee block,  and she politely explained that those products are not provided by them.  the only thing they cover is the time for the anesthesiologist. So I have to go back to Leslie @ Treasure Valley Hospital to make sure the cost of the drugs is covered by the procedure quote they gave me.

Combined

With the information I had above I need only two additional pieces of information,   

• Whether the cost of medications administered by the anesthesiologist are covered by the procedure cost quoted by Leslie at TV Hospital
• What the discounted cost from Dr Lewis/ISMI would be when combining both 29888 and 29881.   (I am also curious about the cost through Blue Cross of Idaho or for the self pay rate)

I received calls back from Leslie at TV Hospital and Penny at ISMI,  and I found a little bit more information about the costs.

• Leslie confirmed that all of the costs of the procedure are indeed included in the codes she described to me.   On thing that helped me understand a bit more about the way that TV Hospital prices,  and Blue Cross of Idaho pays:    The costs of the two procedures was based on the first (more expensive procedure) at full price and then the second procedure code was reduced by 50%.    Anyhow,  she confirmed that the total cost from TV hospital would be $5562.07.
• Penny described in more detail the cost break down of the ISMI Dr (Dr. Lewis)  The cost is 
• 29888 - $2875
• 29881 - $1595 - Blue Cross discounts this second procedure by 50% so the amount I have to pay towards it is 797.5
• She also identified a new cost,  the cost of an assistant for the surgery.   I am a bit confused about the cost of the assistant as it oddly coincides with the full cost of 29888 but my understanding is that the cost of the assistant is also $2875 but that BC discounts that price to 20% which would be $575.

So,  the total of the costs are

• ISMI - $4247.5 (2875+797.5+575)
• TV Hospital - $5562.07
• Anesthesiologist - $610

For a total of 

• $10419.57

 

------- edit to add

But wait,  there's more I decided I would move forward. And when they asked when I would like to get this done I said "Monday"  because I want to get it over with so I can be healed up when I travel internationally to Vietnam. (Also I need to get back in shape, I've already gone too long without soccer)

She says well we can't do it for 5 more weeks at treasure valley (since dr lewis only has thursdays at TVH) But we can do it in two weeks at St als since they are not as booked up.

I asked whether they have another surgeon that could do it and she said, well we don't really do that.  I responded thouh that I do that. (My point being that the dr i paid good money to doesnt own my business) then she said that none of the ISMI surgeons would take someone else's patient. 

So now I have to look at the amount that blue cross is contracted to st als for.   I call at als at 208.367.cost and a lady by the name of Gaye picks up and let's me know the combined price of my two procedure codes was more than 20k.  

So it looks like the decision to me is whether 3 weeks of wait time it worth 19k instead of 5562 for the hospital portion.

You would think that with this decision I would just decide to save my insurance company some money and go with the July 23rd surgery time.  But no, ISMI has left a bit of a bad taste in my mouth by introducing their politics into my ability to choose,  I had to keep looking.

I ask a nurse friend of mine if she knew any other surgeons that might be able to get things done more quickly.  Turns out she did.  She recommended that I look up Sean Hassinger at Allied Orthopaedic.  They are located in the same building as DOC, which is the walkin orthopedic facility and he got me in same day.  I don't think he would have been able to do this for just anybody but it sounds like he extended his day on a favor to the high powered nurse friend.  So here I am again seeing another Dr to potentially schedule the surgery.  The only difference now is that I understand all of the costs (Dr hassinger provides surgery at treasure valley) and the entire patient visit is predicated on a plan for a quick turn around surgery.

Dr hassinger is in network at blue Cross so the pricing is the same as ismi.  My nurse friend and I exchanged text messages about it on Tuesday late nite. She talked with Dr hassinger at non we essay and he ft me into a busy schedule at 4pm that day.  He agreed I needed ACL reconstruction and meniscus repair, but differently than dr lewis, he was able to test me knee and from a fail confirm that I had a  missing ACL.  While lewis had said it was optional hassinger said they would not do the Meniscus removal/repair without the acl.  Since my body had maybe been coping with the acl as the primary knee stabilization for 20 years.  To have the secondary stabilization partially removed (Meniscus)  would leave the knee in bad shape.  Additionally he had a recommendation that at my age I go for the cadaver tendon in my acl reconstruction I stead of using my own tendon from my patella.  The recovery with the cadaver is 3 month longer but at my age (sheesh) the extra 3 month is nothing compare to the horrible pain of the patella bone cutting and knee slicing they have to do for the patellar.

Then,  he awesomely scheduled me for surgery only 6 days later. (June 23rd )

His office immediately contacted me to tell me about the continuous movement machine that will help for faster recovery.  They said the machine was mobile and j will need to put my full leg in it 3 times a day and it will keep my knee flexing for a period of time to keep the scar tissue down.  This is 50$ day and since he was not able to get me in to a post op appt for 17 days (he normally likes to see you 7 yo 14 days after) the cost will be 850$ for the machine. This cost is not anything I expected and neither of the the drs or offices described the potential for the cost before the surgery.  For future procedures I will be sure to always ask about any post op items.  Anyway, they also said that blue cross will cover the cost and it is already pre approved.  I did not check the rate it is preapproved at since the time between the pre op and surgery appt was 6 days and I had hospitals calling and  3 days of MBA school including a culminating presentation and a smaller pitch for year two to complete in that time.  The 50$may be the blue cross rate or it may be the precontracted rate. Either way it adds 850$ to my procedure.

I am sure I will find out about the additional costs of a physical therapy regimen at the post op.