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How much does a surgeon get paid from insurance for a TKR in New Jersey?

Posted , 8 users are following.

dianne62
dianne62

My doctor is out of network on my insurance plan and I would like to know how much doctors are being paid for this surgery from insurance companies.

0 likes, 18 replies

18 Replies

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  • tom67073
    tom67073 dianne62

    Posted

    Stay with in network. If not you are looking at around 100k plus
    • dianne62
      dianne62 tom67073

      Posted

      Wow ! Is that how much your insurance company paid your doctor for your TKR? Where did you come up with this amount if it is not what your insurance company paid? 
    • tom67073
      tom67073 dianne62

      Posted

      That is a rough estimate. It all depends on where you have it done. I had my done in pa. Bills totaled around 100k. Now we all know what is billed versus what is paid.
    • tom67073
      tom67073 dianne62

      Posted

      Again that is what the bills were, not what I paid. But with,out of network you will pay a pretty pennie. Go on line and look at your insurance info it will tell you what you need to pay out of network. My guess will be if you use an out of network doctor you will need to pay because it was not an emergency.

  • deb80187
    deb80187 dianne62

    Posted

    I am on Ohio and had a right knee replacement and all together with hospital stay, pt, meds anesthesia, the actual implant and Surgeon fees and miscellaneous about 50K.
    • deb80187
      deb80187

      Posted

      Deb from Ohio and that was in network...I had a great Surgeon and entire experience. 8 weeks out now!
  • deb80187
    deb80187 dianne62

    Posted

    I am on Ohio and had a right knee replacement and all together with hospital stay, pt, meds anesthesia, the actual implant and Surgeon fees and miscellaneous about 50K.
  • Oldfatguy1
    Oldfatguy1 dianne62

    Posted

    Reimbursements run differently depending on how the practice is set up. Some are owned by hospitals, some privately. You have to take so many things into consideration......the paid reimubursement in my area where I go is around $12000. However, the Dr gets nowhere near that in his pocket. He is paid a salary and some form of profit split. These things are so structured and planned you see a really good surgeon with tenure will make more than a guy with just a few years in practice. Unless you actually saw a Dr's contract you haven't an idea what he's actually making. Before people become obsessed with Dr's salaries, many of these people come out with school loans of over $100000.

    • dianne62
      dianne62 Oldfatguy1

      Posted

      As far as I know all Insurance Compaines have to send out an EOB (explination of benifits) which shows the exact amount paid to the doctor. I am not debating or obsessed with how much anyone makes all I was asking was if anyone knows for a fact what their Isurance paid the Doctor for a TKR in New Jersey. Thanks anyway.
    • Oldfatguy1
      Oldfatguy1 dianne62

      Posted

      EOB shows what its paid to the practice, in essence. For example, my wife recently fell and broke a hip. The PHR was done by a Dr in a practice that is owned by a hospital. The billing and payment shows the payment going to the dr when it actually funnels into the hospital and the Dr is paid a base salary. Again, really hard to tell how you could divide everything up to know what the Dr is being paid on an individual basis. About the only way you would ever really know is off The Dr was a lone wolf in a private practice. Not may if any of those left.
  • audreys130
    audreys130 dianne62

    Posted

    I often wondered how much my bilateral TKR and 6 day hospital stay would cost if I had to pay. Based on these numbers - OUCH!!! As a Canadian it cost me nothing.
  • david_61958
    david_61958 dianne62

    Posted

    I heard $1400.
    • Oldfatguy1
      Oldfatguy1 david_61958

      Posted

      In New Jersey non medical people get more than that for busting them up......right Chico?
    • david_61958
      david_61958 Oldfatguy1

      Posted

      Sorry, my bill was for $46,000. Medicare according to my doctor said he only gets $1400. And he was bitching because he said Medicare cut it down to that. I m in fla.
    • dianne62
      dianne62 david_61958

      Posted

      I believe your doctor is correct, I have also been told that is all a Doc gets paid through Medicare. Docs in network do not get a whole lot more from what I have heard. I was hoping that someone would have an EOB where it shows exactly the amount that was paid to the Doc for the surgery in New Jersey. Thanks for the responce. 
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