Orthognathic Surgery - comparison shopping

[newyorkjackie]

Hi everyone,
I'm in the NYC area, and I was looking for help on pricing out orthognathic surgery. Almost every doctor I call will not "quote on the phone," which I understand since everyone's case is different, but I wish they would at least be able to give you a ballpark. I don't want to spend $250-$500 per consult just to be told it's a procedure I will never be able to afford. Does anyone have any tips on

1) making a short list of doctors to see
2) how to get a helpful price quote in the first consultation. I want to make sure I get a comprehensive listing of all the expenses -- surgeon & anesthesiologist fees, hospital stays, medication, etc. How do you lock-in that pricing given the surgery takes place so far in the future? And any tips on negotiating?
3) what records to bring to each visit to avoid multiple x-rays, etc, and a polite way to ask to keep your x-rays/models from each visit.

Thanks!
~Jackie

[bmueller]

Not sure you'll be able to get quotes on the phone. Does your othodontist have a reccomended Oral Surgeon or a few? I would make that my short list.

To summarize, my surgery in DC metro were priced at $7k lefort, $7k BSSO, $3.5k Genio. I received this quote when I went to my initial consultation. The surgeon was out of network so I paid about $7k total for associated xrays consults supplies and surgery.

Nobody would confirm a cost or cost estimate for the hospital or anesthesiologist.
Hospital costs were $20k for a 23 hour outpatient (but was in-network so I paid $150). Anesthesiologist was $4,750.

My surgeon locked in the price as of my consultation appointment. I'm not aware of any negotiating potentials.

Let's face it. You don't want to go cheap and have some quack doctor mess up your face. Given an approximate estimate of how much it should cost (for me $35k without insurance/ $10k after insurance paid), you should be able to decide whether you want to do it or not. Do you know if insurance will pay for some of this?
From there, I suggest you pick the best rated surgeon that you feel most comfortable with. Truthfully, I would have paid a million dollars to have my surgeon work on me. He did an excellent job and has superb chairside manner.

[Vantwins]

I would probably eliminate any doctor who was willing to negotiate, to be honest!

I was told who was the best of the best in my area, but didn't even do a consultation with him because he doesn't take insurance.

So, I went with a supposedly good doctor who was in network and he totally botched my SARPE surgery and had me working with an ortho who didn't know what he was doing.

Now I'm with the best of the best, and he's going to try to fix the mess the other surgeon left when he does my double jaw surgery next year. I'm kicking myself for not going to see him in the first place. I mean...this is MY FACE...what was I thinking going with second best to save a few thousand dollars?

I understand you need to go with what you can afford, but after my experience, I'd rather not get it done that risk a bad result. I'm sure there's some fabulous surgeons in NYC.

Vanessa

[katsface]

I was completely unable to get any meaningful estimate no matter who I talked to. The surgeon told me some ballpark figure for how much my first procedure would cost, like$11,000 or so, which turned out to be less than half of the actual cost (this was the hospital, surgeon, and anesthesiologist bills). Just the hospital bill (that the insurance co is now trying to deny even though it was pre approved) is over $20,000 for an outpatient procedure.

Not to knock medical professionals and all, but I saw a nurse post something on facebook like "the H stands for Hospital, not Hilton". All I could think was, I have a $20,00 bill, and I didn't even get to spend the night. It better be a hell of a lot better than the Hilton! (Sadly, it wasn't). And that's $20,000 that doesn't include paying the surgeon or the anesthesiologist!

On the flip side, I payed the surgeon up front, and they ended up refunding me a couple hundred dollars because apparently they charged me incorrectly.

Sorry I'm not any help. But good luck finding things out! It seems no one in my area knows what anything actually costs, or they aren't willing to share that information until it's too late.

[Eternal]

I wouldn't count on getting an accurate quote from anyone.
I called the Beth Israel BILLING department to see how much the surgery would cost AFTER they already sent the info to the insurance company and they couldn't tell me how much it would be. They couldn't even give me an estimate.

so yeah...

BTW, I recommend going with a doctor that's affiliated with an actual hospital rather than some doctor than has his own practice.
I'm almost positive my underbite is completely cosmetic, but it was approved in less than a week by the insurance company.

[sirwired]

Search around if you are having trouble finding a doctor... you may want to try the faculty of the nearest Dental School with an OMFS dept. Most of them take insurance, I believe. A professor in the OMFS dept. is likely to know what they are doing...

Around here, (Raleigh, NC), the UNC-Chapel Hill Dental School faculty (and their residents, which you don't want) are, in fact, the only OMFS surgeons who accept medical insurance at all, except for one guy in the plastic surgery dept. at Duke.

My surgery will be done by the head of the residency program at UNC-CH, and it will all be covered by insurance.

I think that it's important that whomever you choose is experienced in doing orthognathic surgery. Most Oral Surgeons spend their days doing extractions and implants, as they are low-risk, quick, procedures that don't involve them fighting with medical insurance companies.

But yes, nobody likes producing estimates because they fear they'll be held to them, even if they incur additional cost. It makes sense that they still won't be producing an estimate even after going to insurance, as the pre-approval process is about medical necessity, not pricing. (Pricing is worked out as part of periodic contract negotiations with an insurance company and usually aren't done on a per-procedure basis.)

[Eternal]

I called the insurance company to see how much they were covering after it was approved and I couldn't get an answer out of them either. The rep on the phone transferred me to another division who in turn transferred me back to the first division...

There's a big difference between an oral surgeon and a maxillofacial surgeon.

Don't go to just an oral surgeon.

[sirwired]

I called the insurance company to see how much they were covering after it was approved and I couldn't get an answer out of them either. The rep on the phone transferred me to another division who in turn transferred me back to the first division...

There's a big difference between an oral surgeon and a maxillofacial surgeon.

Don't go to just an oral surgeon.

The insurance company doesn't approve a fixed amount of money; they approve a procedure. That's why you can't get a cost out of them.

And THIS IS SPAM PLEASE REPORT IT TO THE ADMINISTRATOR. THIS IS SPAM PLEASE REPORT IT TO THE ADMINISTRATOR. THIS IS SPAM PLEASE REPORT IT TO THE ADMINISTRATOR. THIS IS SPAM PLEASE REPORT IT TO THE ADMINISTRATOR., technically you can't go to "just an oral surgeon"; their board certification covers both, and each one will have been trained in the full range of practice. That said, many OMFS's confine themselves to the dental part of practice and don't bother ever "using" the maxillofacial part.

[Eternal]

I called the insurance company to see how much they were covering after it was approved and I couldn't get an answer out of them either. The rep on the phone transferred me to another division who in turn transferred me back to the first division...

There's a big difference between an oral surgeon and a maxillofacial surgeon.

Don't go to just an oral surgeon.

The insurance company doesn't approve a fixed amount of money; they approve a procedure. That's why you can't get a cost out of them.

And THIS IS SPAM PLEASE REPORT IT TO THE ADMINISTRATOR. THIS IS SPAM PLEASE REPORT IT TO THE ADMINISTRATOR. THIS IS SPAM PLEASE REPORT IT TO THE ADMINISTRATOR. THIS IS SPAM PLEASE REPORT IT TO THE ADMINISTRATOR., technically you can't go to "just an oral surgeon"; their board certification covers both, and each one will have been trained in the full range of practice. That said, many OMFS's confine themselves to the dental part of practice and don't bother ever "using" the maxillofacial part.

but they do approve a fixed amount of money don't they? Don't they normally only cover up to x amount? and if they didn't, wouldn't they still know how much they were being billed for?

My doctor is actually a DMD and an MD, that's not to say a DMD by itself is going to be any worse, but being an MD also probably helps.

[sirwired]

I called the insurance company to see how much they were covering after it was approved and I couldn't get an answer out of them either. The rep on the phone transferred me to another division who in turn transferred me back to the first division...

There's a big difference between an oral surgeon and a maxillofacial surgeon.

Don't go to just an oral surgeon.

The insurance company doesn't approve a fixed amount of money; they approve a procedure. That's why you can't get a cost out of them.

And THIS IS SPAM PLEASE REPORT IT TO THE ADMINISTRATOR. THIS IS SPAM PLEASE REPORT IT TO THE ADMINISTRATOR. THIS IS SPAM PLEASE REPORT IT TO THE ADMINISTRATOR. THIS IS SPAM PLEASE REPORT IT TO THE ADMINISTRATOR., technically you can't go to "just an oral surgeon"; their board certification covers both, and each one will have been trained in the full range of practice. That said, many OMFS's confine themselves to the dental part of practice and don't bother ever "using" the maxillofacial part.

but they do approve a fixed amount of money don't they? Don't they normally only cover up to x amount? and if they didn't, wouldn't they still know how much they were being billed for?

My doctor is actually a DMD and an MD, that's not to say a DMD by itself is going to be any worse, but being an MD also probably helps.

They work out how much they are going to pay for the surgeon's fee and hospital bed fee per night, and they've negotiated prices for each line-item. But since they don't know precisely what other resources you are going to need, they really don't know the total. For instance: How long will you be under? (The last surgery I had charged for Anesthesia services (including the doctor and anesthetic drugs) by the minute.) What pain meds will you need? How many bags of IV fluids? Which antibiotic will be judged best for your case?

The bill for the surgery I had in August was two pages of very small type... every last pill, injection, etc. was itemized separately, along with the list price, what insurance paid, and what I paid. (Some of the prices looked reasonable... some, like $120 for a bag of IV fluid that I KNOW costs about two bucks, were crazy.)

Each of those individual items will have a certain negotiated price, but they don't get all bundled together ahead of time.

[Alicia0913]

I also had a really tough time getting estimates. I find that independent surgeons are usually more willing to provide a rough estimate up front (i.e. private practices) whereas surgeons in hospitals tend not to do that -- red tapes in big hospitals, presumably.

Standard surgeon fees in the US seem to be about 10 - 15k per jaw. Hospital fee can be much higher but thankfully I haven't heard of ppl paying too much hospital fee out of pocket.