Medpor Surgery Cost and Insurance Information

* Always obtain surgery costs and insurance information directly from your surgeon of choice’s office. Your surgeon’s staff is experienced at handling insurance inquiries and can help you obtain accurate and up to date information that you will require prior to planning for surgery. Surgery fees are always subject to change and are affected by insurance changes that may occur annually through your insurance provider.

* Insurance fees and final billing figures can vary quite a bit. Some changes that can be reflected in final billings along with adjustments are: the location where the surgery took place, the duration of the procedure, additional requirements (surgical items, etc…) needed during the procedure, medical assistant or additional attending physician/surgeon, anesthesiology fee per hour, etc… This can make medical bills and insurance negotiated rates very confusing. Seek the advice of the surgeon’s office and your individual insurance representative on all final figures.

Surgery costs to have Medpor or Rib Graft surgery performed along with Atresia Repair surgery may cost anywhere between $55,000.00 (USD) to over $100,000.00 (USD) per ear. This may not include travel expenses. Depending on where you are traveling from, how long you have to stay, and what you end up doing, travel expenses could range from $6,000.00 to over $30,000.00

Below are only “examples” of “approximated” fees for what these surgeries may cost. Again, these fees can vary based from surgeon to surgeon and how much the medical facility/surgery center charges. The following is only meant to provide you with an idea of how much these surgeries may cost for your peace of mind…

Approximated Cost for Medpor Surgery With Insurance Coverage:

1a. Anywhere from $20,000.00 (USD) to $30,000.00 per ear. These fees may or may not include “other” associated fees such as medical facility/surgery center and anesthesiologist fees. So, for example the Medpor surgeon may bill for $25,000.00 for the surgery, with a facility fee of $16,000.00, and anesthesiologist billing for $9,000.00 for the remainder amount.  * If you find a surgeon who is “in-network” with your insurance coverage plan, many families may end up paying a total of anywhere from $0 (USD) to about $2,500.00 (USD) depending on your deductible and copay.  Also, just because a surgeon may be considered “out-of-network” does not mean that you and that surgeon’s office can’t help get that surgeon to be considered “in-network” and have better coverage.  Many surgeon’s offices have specialized staff who are experienced at working with insurance companies and finding the best possible way for you to be able to afford these surgeries.  Please don’t be discouraged.  It is always possible to appeal if necessary and the staff at many surgeon’s offices can help you with this paperwork as well if for some reason your insurance denies your coverage for one reason or another.

Approximated Cost for Medpor Surgery Without Insurance or for International Patients:
1b. Medpor Approximately costs between $35,000.00 (USD) to $55,00.00 per ear. These fees may or may not include “other” associated fees. Additional fees may not apply such as Hospital/Medical Facility Fees and anesthesia fees.  Some families have paid a total cost of up to $50,000.00 (USD).  * A discount may be applied due to not having insurance coverage, private insurance coverage or for traveling overseas from another country. However, you may be asked to pay in full or to pay a certain amount up front, prior to surgery.

Approximated Cost for Combined Atresia Repair and Medpor Surgery:

3a. Atresia Repair and Medopr being combined in one procedure can cost between $50,000.00 to $65,000.00 per ear. There is no medical code for the combined procedure so it may be denied even if you have insurance coverage. In this case, the offices of the Medpor and Canalplasty surgeons can help you appeal and begin filling out all appropriate documentation required in order to file for reimbursement.

* Each insurance plan’s policy is different with varying coverages. Only your insurance company can advise you of your actual costs.

Below is just an “example” of a partial break down of a bill for Canalplasty that was shared with me by one parent from our support group (these costs may vary greatly):
Dr. Roberson atresia repair (3 hr surgery):
Waverly surgery center, billed = $27,950.00 (USD), Insurance negotiated Price = $7,830.00
Dr. Roberson, billed = $18,250.00, Insurance negotiated Price = $5,122.00
Anesthesiologist, billed = $1,900.00, Insurance negotiated Price = $1,900.00

Out of pocket/negotiated pay for patient: $14,852.00 (still, additional fees may apply to this figure)
* All depending on insurance coverage and negotiated fees. Each insurance plan is different regarding negotiated actual out of pocket costs. Only your insurance company can advise you of your actual costs. When you are getting quotes from offices, make sure to get the amount for the surgery center/hospital because that fee may be a majority of the cost.

Below is just an “example” of a partial break down of a bill for Medpor surgery that was shared with me by one parent from our support group (these costs may vary greatly):
Dr. Lewin medpor (9 hr surgery):
Cedars-Sinai surgery center, billed= $94,757.00 (USD), Insurance negotiated Price = $47,378.00
Dr. Lewin, billed= $32,639.00, Insurance negotiated Price = $4,371.00
Anesthesiologist, billed= $6,222.00, Insurance negotiated Price = $3,168.00

Out of pocket/negotiated pay for patient: $54,917.00 (still, additional fees may apply to this figure)
* All depending on insurance coverage and negotiated fees. Each insurance plan is different regarding negotiated actual out of pocket costs. Only your insurance company can advise you of your actual costs. When you are getting quotes from offices, make sure to get the amount for the surgery center/hospital because you can see that can be a majority of the cost.  Please see below:

If you find a surgeon who is “in-network” with your insurance coverage plan, many families may end up paying only a total of anywhere from $0 (USD) to about $2,500.00 (USD) depending on your deductible and copay instead of thousands of dollars.  Also, just because a surgeon may be considered “out-of-network” does not mean that you and that surgeon’s office can’t help get that surgeon to be considered “in-network” and have better coverage and have a total out of pocket as mentioned above (between $0 (USD) up to $2,500.00 (USD).  Many surgeon’s offices have specialized staff who are experienced at working with insurance companies and finding the best possible way for you to be able to afford these surgeries.  Please don’t be discouraged.  It is always possible to appeal if necessary and the staff at many surgeon’s offices can help you with this paperwork as well if for some reason your insurance denies your coverage for one reason or another.

How Do I know if the Surgeon I Have Selected Is Covered By Insurance?

Once you have selected your surgeon of choice, contact his/her office and have his/her office run your insurance so you know what you may be looking at dollar wise. Also, the surgeon’s office can tell you if they accept your insurance or not. For example, some surgeons do not accept TriCare or Blue Cross/Blue Shield, but do however accept a majority of most other insurances.  *  Again, it is always possible to try and get your surgeon of choice to be covered as “in-network” with the help of that surgeon’s office staff in order to have better coverage for the surgery.  Just because a surgeon may be termed “private” or “out-of-network” does not mean that they can’t become “in-network.” 

How Do I Plan To Come To the United States For Surgery If I Am An International Patient?

Contact your surgeon’s office whom you have decided on having surgery with. The office should be able to provide you with the appropriate documentation that will be required to be filled out in order to come to the US for surgery. You must take appropriate measures when traveling abroad to have surgery! For example, you can not utilize a work Visa for having surgery nor can you travel to have surgery claiming with your passport that you are strictly here for vacation or business. There are necessary forms and documents that will cover you legally for traveling during surgery. With the appropriate documentation, you should have no problems traveling abroad for surgery.  http://travel.state.gov/content/visas/en/law-and-policy/laws-and-regulations/us-visa-policy.html

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