Hi Carlo,
My wife works in medical billing and recommends you call different hospitals and ask how much they charge for these procedures. She said to verify the procedure codes with the surgeon and it will help you in your search. According to her CPT code book (accepted all over the US, and probably internationally), the codes are as such:
62362 - pump installation and programming ($470 is Colorado's Medicare maximum allowed, physician's charge only)
62350 - catheter installation in the spine ($440 is Colorado's Medicare maximum allowed, physician's charge only)
95990 - Baclofen refill and maintenance of pump
J0476 - Baclofen for the trial procedure, 50 Mcg
J0475 - Baclofen, 10 mg times however many to fill the pump (10 mg x 4 units for a 40 mg pump reservoir)
Hospital charges will be much higher than physician's, though what they charge and what the insurance companies will pay are hugely different! For example, my wife had ulcerative colitis, so her colon was removed last year as part one of the J-Pouch procedure and was in the hospital for six days. The hospital charged the insurance $65,400 just for her stay, but the insurance only paid $5,830. The surgeon charged $3,300 and was paid $2,200 from the insurance. The pathologist charged $780 and was paid $143. The assistant surgeon charged $645 and was paid that. The anesthegiologist chrged $5,200 and was paid $2,135. Our only copay was $750.00. Her second procedure a few months later (to remove the ostomy bag and reconnect the small intestine to the new pouch) kept her in the hospital for three days, so the cost was less.
There are no "carved in stone" charges for any medical procedure, because there are so many variables from state to state, doctor to doctor, etc. She said the costs will differ drastically for inpatient versus outpatient procedures, and also for differing insurance companies and benefits. If you can find out the Medicare allowable charges for your state, that's a good start to gauge expenses.
A friend's son has the Baclofen pump, and he gets them refilled at Children's Hospital here in Denver for $2,700 every few months, but they have Medicare. I asked my neurologist how much I would pay if I used cash (no insurance), and she said about $1,250. Someday I may leave my employer and be able to freelance from home full time, but I'd lose my health insurance.
I am having the procedure in June 23rd. It looks like my copay will be considered outpatient, so $400 for the procedure and one night in the hospital. If anything goes wrong and I am required to stay longer than 72 hours, it becomes inpatient and I have a $1,000 copay (my insurance in Blue Advantage from BCBS). It's nice that my wife is a certified medical coder - we shouldn't have any unexpected expenses.
Good luck - I'd be curious to read what you find out.
David
This post has been edited by davebahm: 30 May 2006 - 12:58 AM
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