In this country the medical payment system is hopelessly complicated. No one fully understands it. We spend incredible amounts of money trying to run and control it. If you were to enter a hospital and pay for a hip replacement privately, it would cost you $40,000 to $50,000. The government (Medicare and Medicaid) pays hospitals about $8000 and surgeons $1000 for this operation. I have determined that hospitals (using the best joint implants that cost $7000 each) can probably provide the service at a cost of $15,000. I would estimate $18,500 to allow a reasonable profit. 70% of joint replacement patients are covered under Medicare or Medicaid.
To make up for tremendous losses from government plans, you can see why hospitals charge so much for the insured population. I estimate my office overhead cost for providing these services is approximately $1500.00, which means I would actually loose $500 on each government insured patient on whom I performed surgery. This calculation illustrates the tremendous damage the government does as it distorts the payment system.
Meanwhile, if you believe the politicians, they have created a great system that does an excellent job controlling costs. I contend that shifting costs of government-provided care to the private sector is actually a devious, non-transparent scheme. I have opted out because I can no longer justify paying the government $500 every time I treat a patient on Medicare.
My global prepayment contract was developed to offer joint replacement to anyone who does not have insurance coverage at a reasonable cost. We can offer these rates because we know we will receive the full payment, and we will not have to devote office resources to seek late payments from insurers. If your insurance company does not have a contract with our hospital, or us they certainly can choose this option as well; however, they must prepay the entire amount. This offer is not valid after services have been rendered.