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Knee Surgery Out-of-pocket Expenses

Posted Jul 11 2009 12:01am

New hope for damaged knees .  After more than twenty years of competitive running, the cartilage on my knee was destroyed and I could no longer run.  My determination to run again and to continue being active for many more years to come led me to Dr. Brian Cole, head of the Cartilage Restoration Center at Rush University Medical Center.  Dr. Cole has been performing the osteochondral allograft transplant procedure on athletes for 12 years and his outcomes are very successful.   This type of procedure offers an alternative to total joint replacement and enables patients to maintain an active life 12 months after the surgery.


In November 2008, a donor match was identified and I had elective knee surgery to repair my damaged cartilage.  Prior to the surgery, this procedure was preapproved by my health insurance plan and I was fortunate enough to have very good insurance to help cover most of the costs of this expensive procedure.  I have a high deductible health plan, along with a health savings account so I am required to pay $5,000 out-of-pocket before my insurance kicks in.  I knew this much going into surgery, but had no idea what my specific out-of-pocket costs were going to be after the surgery. 


During my preparation for surgery and my long rehab following surgery, I maintained a list of all my out of pocket expenses related to this procedure.   Below is a breakdown of these expenses including the provider’s list price, insurance plan’s contracted price, and my out-of-pocket expense.


(1)    Total LIST price                                           $ 71,138.21

(2)    Total INSURANCE CONTRACTED price      $ 20,187.03

(3)    My total OUT-OF-POCKET expenses          $  7,093.87


Item List
Insurance Contracted Price My Outofpocket Price Notes 
Office Visit $162.00 $70.00 $70.00 Dr. referred me to specialist
X-rays $136.00 $50.00 $50.00 x-rays to diagnosis injury
MRI knee $1,116.00 $706.00 $706.00 MRI to diagnosis injury
Office Visit - specialist $198.00 $116.00 $116.00 Office visit w/specialist
Office Visit - specialit $109.00 $70.00 $70.00 follow-up office visit
X-rays $153.00 $50.00 $50.00 diagnostic x-rays
Blood/urine lab tests $193.78 $50.00 $50.00 blood tests for pre-surgery
X-rays $125.00 $39.00 $39.00 x-rays post surgery
$1,440.00 $576.00 $576.00 anesthesia for surgery
Physician's fee 
$22,676.06 $3,221.50 $1,845.00 partial applied to my deductible
Surgical Assistants
$5,668.00 $547.65 $109.51 paid 20% of contract price (met deductible)
Facility Fees
$32,444.37 $11,160.88 $2,232.16 paid 20% of contract price (met deductible)
DME - Knee Brace $897.00 $603.00 $118.80 paid 20% of contract price (met deductible)
DME - CPM machine $3,225.00 $972.00 $194.40 paid 20% of contract price (met deductible)
DME - Ice,
$595.00 $595.00 $595.00 not covered under insurance plan
Physical therapy (10 sessions) $2,000.00 $1,360.00 $272.00 paid 20% of contract price (met deductible)
TOTALs $71,138.21 $20,187.03 $7,093.87  

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