Ablation Insurance/costs

Having finally recd an accounting of my Oct '23 ablation at St David's in Austin, I am curious about other's experience. The "unnegotiated" (cash) total hospital services price (not including doc's bills, which in comparison were minimal) was about $286K. Of course, the negotiated amount, $55K, actually paid by Ins (BCBS) was unrelated to the cash price. I paid about $1600. (Good insurance - don't grow old in the US without it).

Questions: I am curious of 1) the price tag others have experienced? and 2) How receptive are Ins companies to second, third ablations?

Thanks for any info you can offer.

The cash on the barrelhead price vs billed/wishful price are almost certain to be separated by close to 50%. My Canadian dad had to airlift my mum back to Canada years ago from AZ. He paid cash, which they accepted with alacrity once he offered it, at half the billed fee.

Ins companies don't like frequent bills for the same thing. There's usually a mandatory interval, and of course the annual deductible. You'd have to pose the question to your particular insurer, but they are usually pretty good at posting their policies on their website. It would be under 'coverage' usually.

quote=swhanson]How receptive are Ins companies to second, third ablations?[/quote]

I can only speak about US Medicare which pays in full (after adjustments and assuming you have a supplemental policy) no matter how many ablations you need.

The numbers you quoted are pretty much in line with my experience. One insurance company paid for 5 of my ablations without uttering a peep. What can they say? If the procedure is deemed medically necessary and their policy covers it, they can't refuse just because it's a repeat. The Affordable Care Act put an end to crap like that.

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swhanson
Having finally recd an accounting of my Oct '23 ablation at St David's in Austin, I am curious about other's experience. The "unnegotiated" (cash) total hospital services price (not including doc's bills, which in comparison were minimal) was about $286K. Of course, the negotiated amount, $55K, actually paid by Ins (BCBS) was unrelated to the cash price. I paid about $1600. (Good insurance - don't grow old in the US without it).

Questions: I am curious of 1) the price tag others have experienced? and 2) How receptive are Ins companies to second, third ablations?

Thanks for any info you can offer.

I have a $750 hospital deductible. It used to be $100. I might had have only paid the deductible (private insurance) including fees to Natale and the anesthesiologist that were covered by my EOP cap.

Depending on your EOP (out of pocket maximum), one may walk away without paying much. Each of my ER’s prior to each ablation maxed out my EOP by the time I had my ablation .

Interesting to know as I am going in onTuesday to the same place, I haven't yet been quoted anything...

St. David’s I presume? Best wishes for a successful ablation. And, enjoy the great food—something to look forward to if you are going through pre-ablation jitters!

I could be incorrect on this but I believe that Federal law requires hospitals to give you (at least) an estimate, unfortunately many hospitals just ignore that requirement.

Yes, St.Davids! I expect my husband will enjoy my food-ai will probably be too nervous!

Why would you be nervous? By the time you get food it's over and done with.

FuzzyDuck-
My experience at St David's was very good. One surprise was that I was asked for a $2500 deposit payment when I arrived. I was able to put it on a credit card, but otherwise I didn't have means to pay that with me. Be prepared. Good luck.

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swhanson
FuzzyDuck-
My experience at St David's was very good. One surprise was that I was asked for a $2500 deposit payment when I arrived. I was able to put it on a credit card, but otherwise I didn't have means to pay that with me. Be prepared. Good luck.

That must depend on your insurance—with Medicare I didn’t have to do this.

I'm guessing $2500 is your deductible. So your insurance company made it clear to St. David's that you were responsible for that much, so that's why they asked for up front payment. That's standard practice. I'm on Medicare now so I never pay a dime for anything other than my premiums, but when I was on employer insurance up until 2020, I always got billed up front for the deductible if I hadn't met it yet. That happened in 2017 when I had my ablation at St. David's, and it even happened in 2018 when I got my Watchman FLX even though that was a clinical trial and Boston Scientific was paying for everything (I got my payments refunded later for the Watchman).

Thanks Carey and Steve!! Carey I find that reassuring!! Steve, that's a bit of a shock!