4 replies to this topic

[LCP_Assistant]

Hi All,

My name is Carlo and I am a recent graduate of the University of Akron in Akron, Ohio. I work part time for a woman that I met last year that is a Life Care Planner for persons with disabilities. I have the exclusive pleasure of doing her research. It has been a very new, yet very real experience meeting her clients. All I can really say is that I continue to learn everyday how special people are and how valuable life itself is.

The case that I am reserching for the Life Care Planner involves a young woman in the Ohio area who's disabilities include bilateral thalamic infarcts with hypoxic encephalopathy and spastic quadriplegia, and the woman is also hearing impaired. I am trying to find out information about baclophen pumps. Mainly things that the insurance company will require. I am having difficulty finding the cost of the baclophen pump insertion, cost of refilling the pump, and how often the pump will need to be refilled.

I am not a medical professional, and this information will in know way be used to treat or advise treatment for this young woman. It is strictly for my research and to familiarize myself with terms and procedures that i am encountering in my research for the life care planner.

Thank you in advance for any helpful information that you might contribute.

-Carlo

[davebahm]

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

Edited by davebahm, 30 May 2006 - 12:58 AM.

[tom71]

Carlo,
I just had a pump implanted on May 8 2006, I spent 1 night in the hospital, the charges billed to my insurance company were $45,000, I was told my pump would need refilled every 6 months, I hope I have given you some general ideas of the charges, and refill time, good luck in your research,but as we know all procedures vary on cost depending on the facility and the surgeon, mine was installed at Indiana University Hospital.
Tom

Edited by tom71, 30 May 2006 - 11:25 PM.

[lori2050]

tom71, on May 30 2006, 11:23 PM, said:

Carlo,
I just had a pump implanted on May 8 2006, I spent 1 night in the hospital, the charges billed to my insurance company were $45,000, I was told my pump would need refilled every 6 months, I hope I have given you some general ideas of the charges, and refill time, good luck in your research,but as we know all procedures vary on cost depending on the facility and the surgeon, mine was installed at Indiana University Hospital.
Tom

Same with me approx. Major costs associated with the procedure is the pump and i think it was about 25-30k. refills are pricey. What surprised me was how much botox costs. Had my shoulder injected and it was about $2000. Make sure they say outpt if it is that. Had to fight w/ hosp because dr didn't pre cert as they claim it as outpt and hospital bills as inpt. I used to work for insurance company so I know what to look for also.

Lori

[josiejose]

OMG, I am so glad I live in Canada.

I was a university student (actually still am) when my disability threw neuropathic pain at me, and I had the medtronic pump (same as for ITB) implanted for pain meds and baclofen as a last-ditch attempt to salvage some quality of life. Thankfully it worked, and I paid nothing for it. I pay the dispensing fee for the drugs themselves during refill, which is approximately $30. The drugs themselves run around $400 per fill (I have 3 drugs in my pump) but are covered by Pharmacare through the provincial government.

I am constantly amazed about how lucky I am to live in a universal health care country, even if it means we wait sometimes for long periods of time. My parents now live in the states and I can't afford to live there too because there is NO WAY I could afford the health insurance or the medical care for my pump. I can't imagine what it is like for people to have to choose between deep debt or being spasticity and pain free.