The Cost For Graves Disease Eyelid Surgery: Medical Billing Example

Mrs. C. has graves disease, which is an autoimmune disorder that can lead to thyroid eye disease (TED). I thought it would be helpful to share the details of the cost for graves disease eyelid surgery.  3 years ago she had her thyroid radioactively ablated.  Due to the radioactive ablation (RAI) the thyroid eye disease started, which caused one eye to open slightly wider.  Essentially you could see a few millimeters of white above her iris on one eye only.   Rodney Dangerfield and Wendy Williams are good examples of people with Graves disease.  In severe cases of Graves orbital decompression surgery is done, which is extensive.  There is another surgery done on the eyelid itself for mild cases, like hers called blepharotomy, which I will refer to as graves disease eyelid surgery.  She had to wait 2 years after doctors measured no increase in the protrusion of her eye and monitored her blood work to ensure thyroid antibodies were gone.  She originally scheduled the surgery for 2019, but due to needing a hysterectomy, had to push it into 2020.  We just received our bills for this surgery and thought it would be interesting to dissect them.

Graves Disease Diagnosis:

Mrs. C. had several symptoms of graves disease / hyperthyroid disorder before she was diagnosed.  She had gone to doctors several times with these symptoms and was told she had anxiety and stress, but nothing to do with her thyroid. During that time she had had thyroid labs done and they were in normal range.  One day while we were driving around Mrs. C. started having some negative health effects, her heart was racing for no reason and felt like it was going to jump out of her chest, she was experiencing tremors as well.  These symptom combined with others had her call her doctor who believed she was experiencing a thyroid storm.  A thyroid storm is a potentially deadly side effect of untreated thyroid problems.  She continued to work while having this condition.  When she got into a thyroid specialist her doctor did multiple tests that confirmed she had Graves disease and that she most likely had it for multiple years before it was finally diagnosed.  Autoimmune disorders often take multiple years and doctors to finally diagnose.  Autoimmune disorders often lie dormant until a large stressor occurs, for Mrs. C. this was most likely the death of her sister in 2014.  She had radioactive thyroid ablation (RIA) in January of 2017.  At the time she did not have any of the characteristic eye symptoms of this disease.

After thyroid ablation it is important to get your medication right, although this is a difficult task.  Everyone responds to artificial thyroid hormones differently.  Her levels bounced around and because of the time between appointments she went hyperthyroid for a period of time, which allowed her eyes to be attacked.  Only 1 of her 2 eyes experienced this symptom and bulged.

Getting Graves Disease Eyelid Surgery At The University of Michigan:

The University of Michigan Kellogg Eye Center is apparently one of the best places in the world to go for this surgery.  This is an outpatient surgery that takes about 5 minutes. We live on the other side of the state, so this included a roughly 6 hour round trip of driving.  We arrived at the hospital at 11 am and were going home by 3pm. Most of this time was waiting in a hospital bed for the surgeon and surgery room to be ready.

Parking is a pain, at the time we were there a massive parking garage was being constructed right across the street.  The hospital building has 2 parking lots and when we got there both lots were at capacity and we had to circle around for someone to leave.

Costs Breakdown For Graves Disease Eyelid Surgery:

We received the following bills for this procedure. As a reference our insurance has a $1,200 family deductible/$600 per individual with 10% coinsurance after that. This is a marketplace Silver plan for Blue Cross Blue Shield of Michigan that we are paying roughly $400 a month for.

Graves Disease Eyelid Surgery Surgeon Bill: $2,496. Our insurance approved $791.76 of this amount and we paid $538.88.  We paid $510.78 to fill up our $600 individual deductible and $28.10 as 10% coinsurance for the remainder.

Anesthesiologist 1: $1,152.  Our insurance approved $300.60 of this bill and we paid 10% coinsurance of $30.06.

Anesthesiologist 2: $1,062. Our insurance approved $245.88 of this bill and we paid 10% coinsurance of $24.59. Receiving 2 anesthesiologist bills seems unfair.  Mrs. C. was not put under for this procedure and although she briefly saw 2 anesthesiologists, this was due to the hospitals scheduling and not our request.  I was present for the visit from one anesthesiologist and she spend roughly 1 minute with Mrs. C.  I’d like a pay rate of $60,000 an hour too.

Hospital Bill: $7,191. The insurance approved $4,800 and we paid 10% coinsurance of $480.

Eye Drops: $50 The insurance covered $28.97 and we paid $21.03.

Total Cost For Graves Disease Eyelid Surgery: We were charged $11,951 for a straight forward 5 minute outpatient surgery.  Our out of pocket on this was $1,095.   The insurance company got the $11,951 bill down to $6,138 and paid $5,043. It’s amazing that without insurance we would been been billed almost twice as much in total dollar cost.

Graves Disease Eyelid Surgery Recovery:

Mrs. C. decided that trying to recover from her eyelid surgery and her hysterectomy at the same time would be too much.  In retrospect both would have been manageable together.  Had we had this surgery in 2019 we would have saved around $500 by my calculation. Since we had already met our deductible in 2019 we would have paid 10% coinsurance on the approved total of $6,138 for a total of $613.80 out of pocket, saving us $481.

Restrictions: With her Graves disease eyelid surgery Mrs. C. had some pretty severe restrictions.  For 2 weeks she could not lift over 5 pounds, squat down or bend over. She could not exercise or do anything to significantly increase her heart rate.  This is because the stitches are very thin and the concern is that any of these activities could cause the stitches to pop.  She had some decent bruising directly after the surgery and wore an eye patch for a couple days.

The worst part of the recovery was being bored and feeling useless because she couldn’t do anything.  Following the restrictions is highly important because unlike with her hysterectomy, you don’t feel pain if you do something against the restrictions, and so many normal everyday actions that are 2nd nature are prohibited with these restrictions.  You have to be constantly engaged and have other people looking out for you to ensure you don’t do anything against the restrictions.    Going forward for the next year she is supposed to wear sunglasses outside.

The Plus Side Of This High Medical Bill:

On a positive note, having this procedure early in the year means that we have hit our deductible for Mrs. C.  We also had an ER visit for our oldest earlier this year, so we are within a few bucks of hitting our total family deductible in February.  For the rest of the year we will only have 10% coinsurance for any additional medical costs.  This is certainly a good thing.

Have you had sticker shock from any medical bills this year? Doesn’t almost $12,000 seem excessive for a short outpatient procedure?

 

 

 

John C. started Action Economics in 2013 as a way to gain more knowledge on personal financial planning and to share that knowledge with others. Action Economics focuses on paying off the house, reducing taxes, and building wealth. John uses the free tool Personal Capital to track his net worth and posts quarterly updates on his finances. Check out the Action Economics archives section for all past posts.

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