Wife has to have hernia surgery: A tale of healthcare in Amerika

[Dueller]

Wife has had a nagging problem with a hernia. It has finally gotten to the point that surgery is immediately necessary. Our health insurance won't cover since it was pre-existing.

It will be handled on an out patient basis with orthoscopic techniques. He will make a small incision and go in to put a mesh screen in the affected area. Five days of home rest; One week of no lifting; six weeks of nothing over 10#'s. We visted the surgeon today to make arrangements.

Surgeon initial office visit/charge $150.00
Surgeon's fee $1150.00 (discounted since we paid cash up front)

Perfectly reasonable and we are appreciative for his discount.

BUT:

Anesthesiologist/nurse anesthesist $1250.00 hmmmm.....a little pricey and absolutely no discount for cash payment. Looked at us as if we had three heads. They even called the bank to verify funds as they disdainfully took our check. WTF???? Surgery is scheduled 10 days out.

Getting a little pi$$ed.

Hospital/Operating/Recovery room: $6,000.0....WTF???
Of course they will discount it by $600 if we pay today. She has to report at 7:00 a.m and will be released to go home around 2 p.m. So 7 hours....or $800/hour. Plus there may be additional miscellaneous charges for which they will bill us later. SHEEEESH.

SOOOOOO....right at $8,000 for a surgical procedure that will take 10-20 mins.

Of course I asked the hospital what they would accept as assignment payments from an insutrancec ompany if we had coverage....about $1400.

I have absolutely NO problem with the surgeoons bil...more than reasonablel. The anest/NA is on the high side. But gimme a frigging break on the hospital crap.


Rant over.

[Zeke]

I don't think he can do it in 10 minutes, or 20, but that's besides the point. I've had this done twice.

I would opt for a non hospital OR. the fees will be a lot less. I'll bet your wife is in the car by noon.

By pass the hospital. Any surgeon should have other arrangements available. My wife's ophthalmologist has a surgery center OR reserved for every Monday of the week. Only major surgeries have to take place in a full service hospital. Any outpatient work can be done in a specialized and downsized center.

The anesthesiologist has your wife's life in hand, they get paid a lot for their services. If you find another location, you might find another gas doctor.

[Dueller]

Zeke....you had it done twice? Same place? How was the recovery?

[Rikao4]

D your paying for the other 5 surgeries that did not ...

your doing your part to ensure...
that while poor / or not legal..
someone will take care of it..

you are ..

hope she gets better quick..



Rika

[red-beard]

Check to see if the medical insurance company, even if they won't pay the bill for you, can get you a deep discount on the service. This is how my insurance works, it is really nothing more than a discount plan for anything less than $5K.

[daepp]

Just make a quick trip down south across the border and show up in one of their ER's with a pre-existing condition. They will be forced to pick up the tab plus all followup care.

Oh wait - that just in America for our illegals.

[notmytarga]

Ask for a rate comparable to what the big insurers are getting locally. They told you the figure. And you will pay cash immediatley. They should bill the insurance to see how that shakes out.

Or they can wait while it is denied . . .

The general anesthesia for this is required because it is a video assisted dissection under the abdominal muscles - impossible to numb it up.

Anesthesia charge would be as stated. Only 1 in 30 cases pay anywhere near that. Medicare $200, MediCaid $175 depending on state. Blue Cross etc - $350. It is time dependant.

[Zeke]

Originally Posted by Dueller

Zeke....you had it done twice? Same place? How was the recovery?

I don't know where your wife's hernia is, but I had an inguinal hernia (men only, I think) first on the right, then 15 years later on the left. The RS was repaired w/o the mesh and I wish the second (LH) was was done the same way. It does take a bigger incision to repair with thread only.

Seems to me recovery was about the same, and it's a b***h. In each case, I was laid out on Vicodin for 5 days, easing up by the 7th. But the surface numbness can go on for months. I'd say that to not think about it took 2 years in each case for a complete healing of the scar and some tenderness. The mesh left a bump and hindered sex for a long time. I've gone back to heavy work in each case within 2 months.

Do a search here on hernias. A couple of us went in about the same time.

[MBAtarga]

Dueller,

Did you happen to mention to them you're an attorney? Maybe they've got it out for you at the onset.

[fuelie600]

Originally Posted by milt

I don't think he can do it in 10 minutes, or 20, but that's besides the point. I've had this done twice.

I would opt for a non hospital OR. the fees will be a lot less. I'll bet your wife is in the car by noon.

By pass the hospital.

+1

The Surgeon should have access/interest in a surgical center. Much cheaper than the hospital.

I had this done twice too - both sides at the same time. Didn't do laproscopic. Both sides were open. In my case, the surgery center saved me money over the hospital OR and put more in the surgeons pocket. I guess you would call that a win/win. I didn't mind the doc making extra $$ while cutting on me...

Recovery took a few weeks to feel comfortable walking, sitting, etc. Took 6-8 months to really heal. Been almost a year and I can still feel it occasionally. Also had/have occasional tenderness after sex.

The anesthesiologist cost as much as the surgeon in my case. Total bill was around $3500 out of my pocket. I carry a high deductible policy.

Best of luck to your wife.

[dewolf]

Glad I live in Oz when the body ain't well. Having an MRI today actually as a public patient and then a consult with neurologist. Cost....$0.00. Ok, so it's not entirely free. I pay $880.00 p.a in my taxes for my whole family. But any and all hospital expenses are surprise free.

[steve185]

Heath care in Canada has to be the best in the world, rich or poor, unemployeed, the one thing we don't have to worry about is access to health care. I thought there was some type of movement towards the same benefit in the States?

Steve
__________________

[Zeke]

Originally Posted by steve185

Heath care in Canada has to be the best in the world, rich or poor, unemployeed, the one thing we don't have to worry about is access to health care. I thought there was some type of movement towards the same benefit in the States?

Steve
__________________

That's not what we hear about your system. I get reports of long waits, etc.

We don't have anything like your system even in a pipe dream. Our system of the ins co's, the AMA, the out-of-control pharmaceutical co's, tort and other factors are so out of kilter I don't think we could ever manage a meaningful change.

And, it's worse in CA than other states. Doctors leave here all the time. The East Indians take their place.

[Moses]

Originally Posted by steve185

Heath care in Canada has to be the best in the world, rich or poor, unemployeed, the one thing we don't have to worry about is access to health care. I thought there was some type of movement towards the same benefit in the States?

Steve
__________________

THAT'S a hoot! Thanks, eh.

[steve185]

There are long waits for trivial things, but, when you need something important or life saving, it's there. Most complaints come from people who are going to the hospital for things they shouldn't be going there for. I suspect the critics of our heath care system in your country have some hidden motive.
Steve

[Zeke]

NO doubt about motive and/or being misinformed. If we knew a better system (and we certainly know there are better systems), something along path of change might build some steam. All we hear about in Canada and the Scandinavian countries is the high cost. Well, it's gotten high here now, we just pay in a different way. Americans don't like taxes. It's part of the heritage. We don't like taxes to the point of being stupid But then if you see how the government spends, the tax thing perpetuates.

[steve185]

We definitely have the taxes.

[Neilk]

Dumb question which I should know the answer being somewhat in healthcare, but can't you talk to the insurance into accepting the bill, but denying it for pre-x. You would still be on the hook for the fees, but you could get the in-network discounts .

How long have you had this insurance? If over 6-18 months, doesn't HIPAA say they can't deny for pre-x?

[fingpilot]

I had this surgery done in sixth grade, the string method. When all is done, you have a string tied to a ball, exiting your sack, and then taped to your leg just above the knee. The scar runs from your hip/beltline along the inner part of the groin to just above the pelvic bone. Mind you, this is 1966. A Catholic altar boy, in a Catholic hospital in a small town (Oxnard, Ca.).

While I had had the 'talk' with my Dad ( a Dentist), it was in a 1962 MGA doing 100MPH along a beanfield road one night on the way home from a sailboat race. I remember hearing the words 'pecker' and 'burn in hell' and something about it didn't get any better even after being married. That was all I 'officially' knew about that.

So I go into the hospital to have this surgery done, most of what they were gonna do was a little unclear, but not to worry, it will all turn out OK. All the docs and nurses knew my Dad, so I felt reasonably ready.

Imagine my horror waking from the surgery, finally left alone in the recovery room, and 'feeling around' 'down there'......

A week or two went by, I discovered that I had to learn to walk again, and in a gown with the back end pretty much open to whoever was behind me. Late one afternoon, a classmate came in to see me, but unlike prior visits, this was a girl, and all by herself. She brought the card, signed by most of the class, saying get well soon, and some homework the nuns had assigned me to keep me reasonably up to speed.

This particular little Catholic girl was a distant friend, but was one of the ones in class that had 'developed' early, and truly was a 'standout' in any lineup. She pulled a chair up alongside the bed and confided (we were the only two in the room), that she had had the exact same surgery a year or so earlier and she had turned out perfectly OK.

So here I am, picturing this bloody yarn-string tied to one of my privates, and trying to figure out how they had done that to this girl. My mouth was hanging open, and she kept asking if I was all right.... she ran out into the hall and got the doc..... He dismissed her, and asked me what was wrong. Of course I spilled the beans, and he fell out of the chair laughing, followed by the entire floor of nurses all laughing their butts off.

It took me a long time to adjust to this deprivation.

[Noah930]

Not covering a pre-existing condition: to a certain extent, you have HIPAA to thank for that kind of problem. Just remember: insurance companies exist to make money. They'd just as soon sell shoelaces if they thought they could make more money doing that than trying to take care of people.

Surgeon's fee: that's about double what I get paid by insurance here in CA to do a routine hernia (don't know if what your wife has is inguinal, umbilical, incisional, or ventral, but I haven't found the payments to be too different between them). The surgery should take about an hour or so. All your post-operative care (by the surgeon) is free, so to a certain extent, factor that into the price you're paying up front.

Anesthesia fee: It's a great gig, ain't it? They make more money than the surgeon. Yet there's really no pre-op work-up they have to worry about, and no post-operative coverage either. No office overhead. They're there for the procedure, and that's it. Complication or pain issue at 2 in the morning? Not their problem. If I knew then what I know now, anesthesia would have been a lot higher on my list of career pathways.

Hospital fee: Sounds like you're having this done at a hospital, rather than a surgicenter. Hospital is going to be a lot more expensive. An OR, there, is staffed and equipped for all sorts of stuff. There's a lot of equipment and staff there that you'll (hopefully) never need in a hernia repair. But you pay for it in that $6K. Not really fair, from your perspective, as your wife has no designs on making use of the neurosurgeon's microscope or heart surgeon's cardiac bypass machine, but that stuff is there and someone's gotta pay for it in the end. That's part of the reason why the cost is so ridiculously high, even for comparatively dinky stuff like an outpatient hernia surgery.

By the way, the equipment for a laparoscopic hernia repair isn't cheap. A couple thousand bucks (less than $10K) would probably pay for all the surgical equipment used in a traditional open hernia repair. With a laparoscopic repair, that television and camera equipment, gas insufflation equipment, special laparoscopic instruments, etc. will run probably 10-20x that.

At a surgicenter, the overhead is a lot less. Mainly that's because the patients tend to be not as sick, and the procedures not as involved. That translates to less staffing, less specialized equipment, etc. Because you don't have to plan for every possible surgical emergency known to man in a surgicenter, it's a lot cheaper to run that kind of place. So the cost savings gets passed on to the consumer. Insurance companies reimburse surgicenters less than what they pay hospitals (even for the same procedure). Your surgeon may or may not operate at a surgicenter.

Overall, the total price you're paying isn't too far off what I've heard for cash pay hernia repairs. I would have guessed about $5-7K at a surgicenter.

Not that any of that makes you feel any better about the deal. But in the end, hope it all works out great for your wife.