$0 vs. $4,000 Out-of-Pocket For The Same Hysterectomy

You don’t have to do a lot of research to understand that healthcare in the U.S. is…complicated. Even the most common procedures can be difficult to procure and pay for, but what if there was a way to make your experience of receiving and paying for healthcare easier? What if you had someone to help you navigate the system for you?

Alternative Reimbursement: You Can’t Pay Less For Healthcare Unless You Pay Less For Healthcare

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Thursday, June 10, 2021, 2:00 PM ET / 11:00 AM ET

The only way to pay LESS for healthcare is to pay LESS for healthcare. This simple statement sounds obvious but is ignored by most employers as reflected in their health benefits. For years, we have depended on the carriers to negotiate the price we pay for healthcare, having a more direct and transparent reimbursement (provider compensation model) is the key to immediately lowering your health benefits cost.

In a post-COVID world, even zero change in employees’ healthcare costs will likely still result in them spending a greater percentage of their income on healthcare. Why? Most household incomes are down so the focus shouldn’t be on maintaining the status quo, but on fighting to reduce overall costs and expenditures.

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Take for example this scenario: A patient in Idaho needs surgery to repair a torn rotator cuff. While not a particularly complicated or unique procedure, there are few care options in the local market. Because of the lack of options, even after shopping around, the best price they can find is $44,000 with the patient guaranteed to be balance billed. 

However, when using a healthcare advocate, things changed. The advocate was able to secure a world-class surgeon to perform the surgery in Las Vegas for a bundled rate of only $12,500. After paying for all travel expenses, including a $2,000 stipend so the patient could relax and recover in Las Vegas, the plan saved over $25,000 on the procedure. 

World-class care, a Vegas vacation to recover, and over $25,000 in savings? It sounds strange, but this is healthcare in the U.S. and this is what advocates do.

Another example: Two similar hysterectomies with vastly different results, in care and price. 

Patient A used their insurance carrier’s website to find a surgeon in-network, assuming they would be paired with high-quality providers. Unknown to Patient A, the hospital had a C-average rating on Leapfrog and a higher rate of accidental cuts and tears than the average. 

This led to a 2-hour procedure followed by second surgery 8 hours later to stop internal bleeding, resulting in a 3-day in-patient stay and a hospital bill of $57,000 for which Patient A was required to pay $4,000 of out-of-pocket. 

Patient B worked with an advocate to schedule their hysterectomy. The advocate was able to find a high-quality surgeon and bundle the procedure so the total cost was only $12,000 to the plan. After a 1.5-hour procedure and a 45-minute recovery period, the patient was discharged the same day, returned to work three days later, and paid nothing out-of-pocket. 

It’s strange, but when it comes to healthcare in the U.S., higher cost doesn’t mean higher quality. If you work with a healthcare advocate, you can secure world-class care and incredible benefits, for less.