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Money Issues


Which will have more out-of-pocket expense, self-pay shock wave therapy or invasive surgery covered by insurance?

Case Study #1
These are actual numbers provided by a patient who compared the cost of shock wave therapy with the cost of an insurance covered invasive procedure. These numbers were given to her by the respective providers in March 2008. She lives in a very rural area, therefore, these figures are very modest when compared with other areas of Ohio.

$   900  Professional Fee or the Physicians Bill
$1,400  Facility Fee or the Operating Room and Post Op Bill
$   600  Anesthesia Fee
$2,900  Total Bill
$1,000  (Deductible Patient Responsibility)
$1,900  Balance
$   570  (Patient 30% Share of the Balance)
$1,570  Total Amount To Be Paid By The Patient When Invasive Surgery Is Covered By Insurance.

This patient paid $1,100 for the shock wave therapy treatment and was back to normal activities the next day. The patient was also a diabetic and felt much better about recovery from non-invasive ESWT than invasive surgery.

Case Study #2
One physician in a rural area will not move forward with invasive surgery until his patients do their homework. They must first go on a fact finding mission to discover how much it will cost them to undergo invasive surgery that is covered by their health insurance. Once they understand that it will cost them more out-of-pocket expense and realize the benefits of ESWT, when compared to invasive surgery, they almost always choose ESWT.

In this rural community patients find that in March of 2009 invasive surgery will cost between $3,500 and $5,000 depending on the type of anesthesia used. Lets look at what the patient is responsible for in this scenario using Case Study #1's deductible and 70/30 insurance structure. Remember, your deductible etc. may be higher or lower than what we are using in this example.

$3,500  Total Bill
$1,000  (Hypothetical Deductible Patient Responsibility)
$2,500  Balance
$   750  (Hypothetical Patient 30% Share of the Balance)
$1,750  Total Amount To Be Paid By The Patient When Invasive Surgery Is Covered By Insurance.

$5,000  Total Bill
$1,000  (Hypothetical Deductible Patient Responsibility)
$4,000  Balance
$1,200  (Hypothetical Patient 30% Share of the Balance)
$2,200  Total Amount To Be Paid By The Patient When Invasive Surgery Is Covered By Insurance.


These are some examples given to demonstrate that self-pay shock wave therapy is as affordable as insurance paid invasive surgery. Of course, prices and deductibles will vary from case to case, but the example provides food for thought.

 
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