How much does a hip replacement cost? $87,736.46 or $17,945.97?
Here’s a full bill for a hip replacement at Montefiore New Rochelle Hospital, just outside of New York City. Disclosure: The bill is mine, for a procedure Aug. 30, 2022.
The total billed was $87,736.46. Listed as “patient savings” was the sum of $70,189.36. What that means is the total bill was the higher amount; the lower amount is the writedown by Medicare and my supplemental medicare plan to the sum of $17,945.97 – Medicare paid $15,773.33, and my Medigap supplemental insurance paid $2,172.64, leaving me with a $0 balance. (I had met my deductible.)
What’s included on this bill: Surgeon charges, cardiac pre-op clearance, one night in the hospital, anesthesiologist and all related charges.
What’s not included: General practitioner pre-op clearance, duplex ultrasound of legs pre-op to rule out deep vein thrombosis, transthoracic echocardiogram, blood tests associated with GP pre-op clearance, pre-op X-ray (two, one at the surgeon’s office and one immediately pre-op), surgeon visit pre-op. The hospital physical therapy is included, but pre-hab PT before surgery and post-op rehab are not included.
The surgeon’s bill of $40,252 was written down by $38,584.79, leaving a total of $1,667.21 – $1,328.35 for Medicare and $338.86 for my Medigap supplemental insurance.
This may seem like a travesty for my hard-working surgeon, but keep in mind that this took him an hour and a half, so that’s not that awful.
Also, in addition to the surgeon’s bill, there was a subsequent entry of $14,511.32 for surgery from the hospital, of which Medicare paid $13,354.19 and Medigap paid $1,556.00, for the total billed price with no discount.
There was also a bill for $493 from a doctor I did not recognize; a quick Google shows him to be an internist at the hospital. He was paid $126.04 by Medicare and $32.15 by Medigap. What he did I do not know.
The anesthesiologist billed a total of $6,250, and ultimately received a total of $500.27, $398.59 from Medicare and $101.68 from Medigap.
A $12,177.04 charge for the implant
Interestingly, they charged $12,177.04 for the implant, but Medicare and Medigap didn’t pay anything, saying “the impact of proper payer(s) adjudication including payments and/or adjustments” was the reason. This is a reflection of the “bundling” practice in billing, where there’s a bundle of payments for a given procedure like a knee replacement or childbirth, instead of the insurer(s) paying for every single item and procedure one by one. My guess is that the implant was bundled into the surgery charge. Here’s a description of bundling for joint surgery.
If you wanted to buy a hip replacement for cash, you might go to MDSave, where they will offer you a contract for a cash price. Sadly, they don’t operate in New York, but in the Kansas City area, they say they can get me that hip replacement for about $19,526. In Killeen, Texas, you can get that hip replacement for $10,333. We also wrote about this before: “How much does a hip replacement cost? $95,459.83 or $77,967? Or $63,604?”
I did intentionally choose to have not Medicare Advantage but instead U.S. Government Medicare and a Medigap Plan G supplemental policy, which I explain in this post titled “What does Medicare cost?” I intentionally chose that because I have heard awful things about Medicare Advantage and went with a more cautious and potentially more expensive choice, in order to avoid an additional bill. Without Plan G, I would have been responsible for the $2,172.64 that Medicare didn’t pay.
So: How much does a hip replacement cost? $87,736.46 or $17,945.97?