INDIAN LAND, S.C. (WBTV) – A trip and fall more than a year ago led to an all-too-common diagnosis: Stephanie Campbell needed a hip replacement if she wanted to keep her mobility.<\/p>\n
At first, she resisted. Major surgery is frightening, and she wanted to try less invasive measures first.<\/p>\n
But when she gradually grew more house-bound and began worrying about keeping up with her grandchildren, she became ready to pull the trigger.<\/p>\n
Her husband helped her schedule the surgery at Piedmont Medical Center in Fort Mill.<\/p>\n
Then came the quote: Nearly $125,000, according to estimate documentation reviewed by WBTV.<\/p>\n
It was tens of thousands of dollars more than the couple had been planning for, and far greater than what most online resources told them was the average cost for the surgery in the Charlotte area.<\/p>\n
It didn\u2019t help, of course, that the couple would be self-pay patients: Joe Campbell\u2019s job as a pastor in Pineville doesn\u2019t include health insurance.<\/p>\n
But unlike many providers, he was told that Piedmont Medical couldn\u2019t offer him a self-pay discount. (A spokesperson for Piedmont did not provide comment for this story, or explain why they did not offer a self-pay discount.)<\/p>\n
\u201cIt just blew my mind,\u201d Joe said in an interview. \u201cWe knew [the expense] was coming; we just didn\u2019t know that storm was going to be a hurricane.\u201d<\/p>\n
Wildly-variant prices for common procedures is hardly an unusual story across the country, according to research professor Sabrina Corlette at Georgetown University\u2019s McCourt School of Public Policy.<\/p>\n
\u201cThis is a feature of the American healthcare system,\u201d Corlette said. \u201cIf you have health insurance, in theory, your health insurance provider is negotiating with the service provider, the hospital, or doctor over the rate. But for self-pay patients … there\u2019s just no guardrails.\u201d<\/p>\n
Federal laws and regulations do not govern what prices providers can set, Corlette said. There is little insight into how each provider determines the cost of a procedure.<\/p>\n
\u201cEssentially, providers are charging whatever they think they can get away with,\u201d Corlette said.<\/p>\n
What is federally required, however, is that providers have to post their prices online.<\/p>\n
That\u2019s how WBTV compared prices for the procedure at Charlotte\u2019s two largest providers, Novant Health and Atrium Health.<\/p>\n
At its Charlotte Orthopedic Hospital, Novant Health lists a self-pay price (which includes a 50% discount from the original price) of about $36,000 for a hip replacement surgery.<\/p>\n
Atrium Health has a similar tool, but does not include a specific option for a hip replacement. However, the more general \u201cjoint replacement\u201d option in their estimator returns a price of about $57,000 at their Mercy Hospital (prices at both providers varied based on location).<\/p>\n
Atrium\u2019s price also included a 50% self-pay discount.<\/p>\n
It\u2019s this kind of shopping around that experts recommend any patient do when shopping for a provider, and it\u2019s what ultimately saved the Campbells\u2019 finances.<\/p>\n
\u201cYou have to advocate, you have to make phone calls, you have to send emails, you have to shop around,\u201d Joe said. \u201cBecause it is going to come out of your pocket one way or another.\u201d<\/p>\n
The Campbells found an estimate of about $18,000 with Matthews Surgery Center, an OrthoCarolina facility. <\/p>\n
The switch to Matthews Surgery Center caused a delay, since the Campbells had to cancel their scheduled surgery with Piedmont. But it was a financial no-brainer. <\/p>\n
Now about nine weeks post-surgery, Stephanie is doing well and the couple hasn\u2019t seen any surprise bills that significantly changed the estimate they\u2019d originally been quoted.<\/p>\n
\u201c$18,000 or $125,000?\u201d Stephanie said with a chuckle. \u201cThat does it for me.\u201d<\/p>\n
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