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.
<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />
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 LISTprice $
71,138.21
(2) Total INSURANCE
CONTRACTEDprice $
20,187.03
(3) My
total OUT-OF-POCKETexpenses $ 7,093.87
| Item | List
Price | 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 |
Surgery
anesthesia | $1,440.00 | $576.00 | $576.00 | anesthesia for surgery |
Surgery
Physician's fee | $22,676.06 | $3,221.50 | $1,845.00 | partial applied to my deductible |
Surgery
Surgical Assistants | $5,668.00 | $547.65 | $109.51 | paid 20% of contract price (met deductible) |
Surgery
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,
Compression
Unit | $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 | |
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.
<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />
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 LISTprice $ 71,138.21
(2) Total INSURANCE CONTRACTEDprice $ 20,187.03
(3) My total OUT-OF-POCKETexpenses $ 7,093.87
Price
anesthesia
Physician's fee
Surgical Assistants
Facility Fees
Compression
Unit