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Cost of surgery at Lodi Memorial Hospital among highest in California

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Posted: Tuesday, July 24, 2012 12:00 am | Updated: 6:48 am, Wed Jul 25, 2012.

The average cost for having knee replacement surgery at Lodi Memorial Hospital is $159,571, compared to $86,002 at Sutter General Hospital in Sacramento.

Lodi Memorial charges $31,907 for a Caesarian section while the same surgery is $17,560 at Sutter.

Those are among the findings in a recent report by the California Public Interest Research Group that shows patients are paying dramatically different base costs for the same surgery depending on where the procedure is done.

Lodi Memorial spokeswoman Carol Farron said hospital costs are complicated and many rates are based on volume.

"What hospitals charge insurers is not actually what they pay. It's just based on negotiated rates with HMOs and PPOs ... and for self-pay patients, we can work out what they can pay," she said.

Hospital pricing is based on a multitude of factors. Unionized hospitals will often have higher costs, according to Jan Emerson-Shea of the Sacramento-based California Hospital Association. Trauma centers or hospitals with burn units can also be more expensive.

Nonprofit versus for-profit status may influence how much hospitals charge.

Statewide, the highest rates are in the Bay Area.

"Overcharges are unacceptable for a service as important as health care," CALPIRG's Daniela Uribe said in a press release. "Consumers, whether it's on their own or through higher insurance premiums, shouldn't be paying 250 percent more for the exact same surgery at different hospitals."

The survey did not include Kaiser Permanente hospitals, nor did it take into consideration costs borne by insurance companies.

Statewide, surgery charges were overall highest in the Alameda and San Mateo areas. The Fresno and Orange County regions charged the least.

For example, the typical patient in the San Mateo region was charged nearly $48,000 for a C-section. For the same surgery in Fresno she was charged less than $13,000.

"According to this data, a pregnant woman in the Bay Area could take a private jet to Fresno, stay at the nicest hotel in the city, and still save thousands of dollars on her birth," Uribe said.

San Joaquin County's rates for C-sections are among the highest, ranging from $28,561 at St. Joseph's Medical Center in Stockton to $57,364 at Doctor's Hospital of Manteca. The statewide median charge is $24,360.

"It might be higher, but it's not what an insurer will pay," Farron said, shifting her attention to Lodi Memorial specifically. "We don't operate at a significant profit. When we do make money, we reinvest it in equipment for the hospital or give back to the community."

Comparing the local hospital to Sutter may be unfair since they are a system of hospitals that have lots of volume, Farron added.

"When it comes to negotiating contracts, they have more leverage," she said.

In the end, regional differences in the cost of living only partially explain the regional variations in common surgery charges, according to the survey.

Other findings:

  • The cost of living in the San Francisco-San Mateo-Redwood City area is 46 percent higher than in the Fresno region, hospitals in the San Mateo and San Francisco regions charge 2.1 to 2.7 times as much as in Fresno.
  • Hospitals with greater market power can charge more. When dealing with insurers, for example, hospitals that serve the most patients and that are part of large hospital networks have more leverage when negotiating with health insurers on prices, who are willing to pay more to retain a key health care provider in their network.

Contact reporter Jennifer Bonnett at jenniferb@lodinews.com.

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6 comments:

  • Ed Ojeda posted at 11:52 pm on Sun, Mar 3, 2013.

    Capteo Posts: 15

    I went to the Lodi Memorial Hospital Urgent Care Clinic in Dec. 2012, and for 5 minutes of the doctor's time and a perscription for extra strength ibuprofen, I was charged $406 plus $25 co-pay. And I HAVE insurance! They didn't even check vitals(good thing or my bill might have been $1000). But because I hadn't reached the $500 deductible, my insurance company, UHC, paid absolutely nothing. I called the billing number and they would not negotiate the price down at all. So when Lodi Memorial Hospital staff say they will negotiate prices, they are absolutely lying through their teeth. I call this medical insurance rape. Incredible.

     
  • Ankur Desai posted at 7:23 pm on Sun, Aug 5, 2012.

    Knee replacement Posts: 1

    That is really expensive.

     
  • Darrell Baumbach posted at 10:02 am on Wed, Jul 25, 2012.

    Darrell Baumbach Posts: 9403

    doesn't work that way. The insurance company will contact the provider of service and verify procedure codes needed to pay a claim. The provider of service will then realize you committed fraud... I would not do as you stated as I value my freedom.

     
  • Robert Jacobs posted at 6:38 am on Wed, Jul 25, 2012.

    Robert Jacobs Posts: 298

    I like that...

     
  • Darrell Baumbach posted at 3:52 pm on Tue, Jul 24, 2012.

    Darrell Baumbach Posts: 9403

    If a medical facility bills $50,000 for a surgery and the insurance company of the patient has a contracted negotiated rate of $43.10, then $43.10 is the maximum the service provider can receive for services rendered. Who cares what the hospital charges if the patient does not have to contractually pay it.

     
  • Kurt Roberts posted at 11:49 am on Tue, Jul 24, 2012.

    Kurt Roberts Posts: 55

    If you are rich and can pay cash, LMH is great!!! If you`re an illegal immigrant or otherwise destitute, you`ll have no problem either, they don`t expect you to pay anyway!! But if you have insurance and are middle class, it is better to tell them that you have no insurance, I guarantee you will be charged significantly less than the average person with insurance!! After getting the lower bill, you can then present it to your insurer!!

     

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