By Craig Gottwals
“This is why telling employers they don’t need the legal muscle and case law precedent of Reference-Based Pricing (RBP) is like saying we can ditch the Highway Patrol — because hey, speed limits are posted now!”
Portlandia Priced My Knee at $62K. Tillamook Did It for $2K.
Welcome back to Wacky Hospital Pricing: Pacific Northwest Edition — where common sense goes to die and your ACL goes to get… creatively billed.
Today’s nonsense? Straight outta Portlandia. Let’s talk knee reconstructions.
“Cash is king! That’s all you need!” some bark.
And they’d be right — if you were headed to Adventist Health Tillamook or Providence Milwaukie. There, the full patella protocol will run you just over $2,000. But mosey over to Adventist Health Portland, and the “cash price” balloons to $62,000. You read that right. Same knee. Same surgery. New mortgage.
Makes perfect sense, right?
This is why telling employers they don’t need the legal muscle and case law precedent of Reference-Based Pricing (RBP) is like saying we can ditch the Highway Patrol — because hey, speed limits are posted now!
Take a look at the attached chart.
🔴 Bold red = highest cost by carrier
🟢 Green italics = lowest cost available
How do we fix this?
Each client’s recipe varies, but typically, our claim payment will end up near 140% of Medicare unless we can access significantly better nearby cash pricing. In this case, employees choosing to get the procedure at Tillamook or Hood River will have their surgery with no deductible or copay — and, in some cases, a $500 thank-you from the employer for making a financially sound choice.
Here’s the kicker:
Think your carrier’s got your back? With an insured plan, you’re likely to fork over $20K+ for this same surgery. Sure, that’s better than $62K… but still laughably high when you could be paying $2K to $9K — every single time — with an unbundled plan, free of carrier shackles.
This is the way, employers.
Now scale it — over thousands of claims, some in the six figures, and reduce them to a fraction of the cost?
Yeah.
It’s real.
And it works.
P.S. There is no CMS star rating for Providence Hood River Memorial Hospital. But never assume that price and quality are correlated in healthcare – they aren’t:
1) Providence Hood River Memorial Hospital has strong patient experience ratings, with 81% of patients recommending it, 12% above the national average, according to Healthgrades.
2) It is accredited by the Joint Commission and recognized as a Level III Trauma Center, suggesting reliable care standards.
3) The hospital has received awards like being a Top 100 Critical Access Hospital and excelling in joint replacement, indicating good quality care.
