The Saga Of The $23,000 Circumcision

*3:15 Update: See Below

On Wednesday, Stephanie Bottner of Somerville, Mass. posted a story on the new HealthCare Savvy website about trying to get a circumcision for her son.

The post begins this way: "I have recently had an interesting experience which left me completely shocked. This is not a posting about whether or not to get a circumcision, just at the astronomical costs involved."

Stephanie continues:

My son was born 14 mo ago and because he was born in a Birth Center, he could not get circumcised at birth. Our hospital (Cambridge Hospital in Mass.) does not have a pediatric surgeon for this procedure so we were given a referral for a doctor at Mass General (Boston). When I called Mass General to get a quote on the price, I got the following:

$23,000
(includes Facility, Physician, Anesthesia)

This procedure is less than 30 minutes; the doctor himself even stated that this is one of the easiest procedures. I’ve researched prices for other countries and found a high of $1200.

We are insured so presumably my insurance (Harvard Pilgrim/United) has a discounted rate but I have not been not able to get access to this price. The insurance would presumably cover 80% of the cost but I would be responsible for co-insurance, deductible, and who knows what else.

It took 15 calls and 3 hours to get the information relating to the $23k. It’s ridiculous that it takes this long but also that a hospital could charge this much.

I called Stephanie to try to get a few more details about her saga.

Here they are, by email:

Because my son was delivered by a midwife, we did not have access to an OB for the circumcision. Normally, if you have a baby in a hospital (even with a midwife), there's an Attending Physician who can come in for the circ and this procedure is more/less 'included' in the cost of the delivery. In my case, there's an Attending Physician for insurance purposes but he/she is not 'able' to perform circumcisions to babies born in a birth center. So my husband and I figured we'd do this at a later time. Now, because my boy is over 1 year, this procedure has to be done in an OR which does up the price.

We take our kids to the Cambridge hospital; they told us that they don't have a pediatric surgeon on staff to perform the circumcision. Our doctor gave us a referral to [a doctor at MGH]. My husband actually met with the MGH doctor at Cambridge Hospital for a consultation, to discuss exactly what would be involved in the procedure. The doctor said a circumcision is 'one of the easiest procedures to perform,' and that it only takes 30 min.

So about a month ago I started making calls to MGH (I had done this same thing in Sept 2010 and hadn't gotten anywhere, so this was my second attempt). I got passed from department to department but ultimately what I learned was that there were 'probably' three items I'd need to get prices for: Physician, Facility, & Anesthesia. The Doctor's office said that the Physician piece would be $762, Anesthesia unknown, and the Facility fee would be around $7,000. A woman from the office stated that the circ surgery is Procedure code 54161 and the diagnosis code was 605 but was unsure if there were more codes involved.

The office woman advised me to call the billing office, which I did and left 2 messages: the first on 6/23/2011 and the second on 7/25/11 but never heard back.

I made more calls and eventually found some information on the MGH website that said to contact the Financial Access Unit. They're supposed to give estimates on procedures. First I spoke with a woman who confirmed that there were 3 charges: facility, physician, and anesthesia, but wasn't sure if the anesthesia would actually include a physician and facility bill as well (in other words we'd have 2 facility, 2 physician bills. She went back and forth with her supervisor (I was on hold for 20 min while they spoke) and they finally came back with the following:

$18k-20k for the surgery procedure. This included the OR outpatient fee of 1.5 hours (facility), anesthesia and a 2nd facility. But did NOT include the physician. I stated that this was a bit confusing and could they help me understand how much each piece was. That's when I was able to speak with the supervisor, who confirmed that it was $18-20k and that included everything but the physician bill. I said that I had a quote of $762 from the doctor's office and would that be within the range she would expect. She said she wasn't sure but figured that the whole procedure would come to $23k.

Actually her quote was: "I would be surprised if it came to more than $23k." (Bold is mine.)

"For that price, I'd just skip it," Stephanie told me. "It's not a critical medical procedure and my son can always decide to do it when he's older." Still, she said, she'd like to know what it would cost her so she can make an informed choice.

We really wanted to learn the cost as well, and to understand the arduous path Stephanie took in her attempt to be a smart health care shopper. So we called MGH to find out:

1. Is that price accurate?
2. And if it is, how can it be possible?

Two days passed. Twice we received email saying that information was coming "soon." Now, with the start of a summer weekend looming, we decided to post the story. If MGH does return our calls and emails, we'll certainly update the piece.

*3:15 Update: In a statement, Paul Pecoraro, MGH Revenue Director writes:

We cannot confirm or deny this actual case as the patient is unknown, however based on clinical indication, if we were to get this case today we would estimate $9,000 - $17,000 prior to any discussion of an uninsured patient discount. Drivers of actual charges include length of time in the operating room and level of care required post procedure. Generally speaking, a complex case with an overnight stay would drive a higher charge.

I called around for a few comparisons.

First, I contacted Rick Morris, the billing specialist at Mt. Auburn Hospital, who told me a circumcision for an adult, which takes about 60-75 minutes including time in the operating room and recovery is about $2888.77 (that's the gross charge, before insurance) and doesn't include anesthesiology and professional services. But even if you double that, Morris said, it doesn't even come close to $23,000. For a recently circumcised three-day-old baby, Morris said, the gross charge was $2,746, and Blue Cross paid a little more than half.

Then I called Rabbi Shimon Miara, a local mohel whose name I pulled off the Internet. He told me he's been doing circumcisions for over 25 years. And he says his basic charge runs between $900 and $1600. For a 14-month-old, he said he would probably arrange to get assistance from a doctor to administer anesthesia, which would up the price by around $500. I asked the Rabbi if he only circumcises Jewish boys. "Oh no," he said. "I do them all."