How I turned a possible $25,000 surgery bill in to $8,000

So many would say I’m an expert in my field, though I’d challenge that many days, because the world of health insurance finance, healthcare services, employer-funded employee benefits is deep….#complianceoverload.

That said, I have a good tail as a said “expert” of a real life situation (I’m giving all a HIPAA release of some sorts on the details!), some self-serving research, and an outcome better than my expectations. It has to do with a full thickness rotator cuff tear that Mr. Genius over here, me, got introduced to a few months ago as a result of overdoing it in my Spring Tennis Leagues. So I’ll save the particulars, but suffice it to say, nonstop pain, horrible sleeping, lots of anti-inflammatory medicine and constant ice for 2 months, and just kept getting worse….that was until I finally broke down, called a buddy and got scheduled for an MRI – so here is where the research started.

MRIs are tricky little buggers and can swing in price by over 500%. Yes, that’s not a typo 500%! So as a self-proclaimed healthcare consumer, I knew in my hometown of Charlotte, NC we were not short on orthopedic surgeons, or diagnostic imaging, so I immediately thought of OrthoCarolina which is regarding as one of the best organizations in the Carolinas. I also have a good friend who is a PA there and helped me navigate to a physician he does tons of procedures with for shoulders, and has incredible bedside manner. So first the MRI which I shopped BEFORE going…$683 negotiated rate in our Aetna network. I paid $383 of it.

Dr. Matt Gullickson is the physician by the way, and I’ll report back after the surgery to make sure everything lined up with the reviews! So, and if I didn’t already make it clear, hospital, pharmaceutical, facility charges are in the wheelhouse of what I do every day, every week, every year…Negotiated rate with our network, Aetna, was a bit over $3500 for Dr Gullickson. The outpatient facility on site where OrthoCarolina practices (not embedded in a hospital system) is $3900. Anesthesia, is $1028. I have a $2,000 deductible and 20% coinsurance, so of the total $8428, I’m out-of-pocket in the range of $3,000 as I had the MRI previously and it went to my deductible. So far, stepping back, I’m stunned by the value they’ve provided me and the dollar spent. The entire process, customer service, staff, have also been off the charts. It’s rare I call out a facility by name, but it was called for this time.

So no one likes to have medical bills, but I can attest, this is very rational, and an efficiently built system they run at OrthoCarolina. We happen to be in our VEBA Trust, which is a huge risk pool of smaller employers that we help run nationally, so we end up having transparency in to these costs, claims, and how they impact our monthly contribution towards medical costs for our own company. If more people do what I did, we fix the health insurance cost crisis ourselves – via consumerism, and slowly.

Before I go on this quick tail,  I implore anyone reading this post to go do some homework on what a train-wreck cost-wise this could have been otherwise. For a reputable orthopedic facility to perform this surgery, with high marks, (again I’ll report back after the services are performed) at this cost-basis is commendable – costs can skyrocket from the price I was dealt – $20k and up and if in a hospital setting it can get completely out of control and often 5-10 x the costs I was delivered.

Regardless of how we feel about health insurance costs, and whether Obama or Trump or someone else could and would fix it, I’m here to tell you we need to fix how much things cost that the INSURANCE pays for before we can fix the cost of insurance. If we get that right, almost anyone can/could fix our health insurance demand problem – we need to get transfixed on the costs of goods (supply side folks, the hospitals, docs, pharma companies) before we use a system to pay for it – ours in the US is still vastly broken.


Ironically enough our VEBA Trust is bending the cost curve quite nicely.