Outpatient surgery center charges $87,500 for 20-minute knee operation

[Newsjock]

Source: Los Angeles Times

A Southern California surgery center charged teacher Lynne Nielsen $87,500 for a routine, 20-minute knee operation that normally costs about $3,000.

Despite the huge markup, the Long Beach Unified School District and its insurer, Blue Shield of California, paid virtually all of the bill from Advanced Surgical Partners in Costa Mesa. Blue Shield mailed the $84,800 check to the high school Spanish teacher last month and told her to sign it over to the surgery center.

... The 61-year-old is the latest patient caught up in a growing battle nationwide over billing by outpatient surgery centers. Industry experts say some of these surgery centers seek out well-insured patients such as Nielsen, sometimes by waiving their copays and deductibles, and then bill their insurers exorbitant amounts for out-of-network care.

... In response to questions from The Times, Blue Shield defended its $84,800 payment as proper. Advanced Surgical Partners, through its lawyer, said the bill was excessive. Amid the scrutiny, the two sides agreed to a lower amount this week.

Nationwide, some insurers have begun to challenge these bills from outpatient centers.

Read more: http://www.latimes.com/business/la-fi-high-price-knee-20130131,0,6980121.story

[kestrel91316]

1. No wonder insurance has become completely unaffordable.

Betcha a lot of these outpatient surgery centers are owned by insurance companies who wind up pocketing that money anyway.

Just one more way to screw the consumer.

[CBGLuthier]

2. That is why surgeons wear masks, just like thieves.

I used to respect them some until I sat in a waiting room waiting for word on my wife's operation then we look out the window and see the studly surgeon driving away without one word.

Bad enough she had to go to Europe to get a correct diagnosis of her condition but then to be treated like a piece of meaningless meat by that "doctor" was the ultimate insult.

[Mosby]

6. The surgeon and anesthesiologist billed seperately from the surgical center

$1,200 combined.

The problem all along with health care costs has been the hospitals and surgical centers (and drug cos). I hope more people start going to the Atty Generals asking to investigate price gouging or whatever, this could a very effective tactic to force the insurance companies to start caring about pricing and not just maintaining their margins.

[KamaAina]

3. Not to worry. Blue Shield will just announce another double-digit rate hike.

Which our insurance commissioner is powerless to stop. If it were any other type of insurance -- homeowners', auto, life -- he'd have the authority to put the kibosh on outrageous rate hikes. But not health insurance.

[smirkymonkey]

4. That is just f***ed up.

What the hell is wrong with this country?

[Initech]

5. We've become a for profit, dog eat dog cess pool that's what.

I had an outpatient knee operation this month. I haven't received the bill yet but $84K is absurd. We should be marching in the streets fighting for single payer.

[niyad]

7. so the insurance company has no hesitation in paying a bill that is almost 30 times what it

actually should be, but will deny their clients coverage for needed medical care. that makes so much sense. . . .