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Thread: Trying to understand surgery costs...

  1. #1
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    Trying to understand surgery costs...

    Dear All-

    I accidentally posted this message in the teen section (thank you, Linda, for catching that) so I am reposting it here hoping that some of you may have be able to advise me.

    I am trying to understand and plan for the financial aspects of my daughter's surgery. I assume that the surgeon's fees are separate from the hospital fees. Does anyone have an estimate of what the various expenses are?

    I suspect that the costs are contingent on the complexity of the surgery...and here's what I know about my daughter's surgery thus far. The plan that we recieved says that he plans to perform a "posterior spine fuson" of "L1-4" as well as a "Smith-Petersen-type posterior element osteotomy."

    I know that Dr. Boachie's office doesn't accept insurance. Does this mean that the patient has to pay the surgeon's fees out-of-pocket after the surgery? Or, are there instances when one can submit the bills to one's insurance company without having to front the cash. Basically, I am trying to figure out how much money do I need to have available for the surgery. Someone else on the board estimated that I should plan on about $5k worth of out-of-pocket expenses but this did not include the surgeon's fees. Does anyone have additional information, particularly if you/your child has had a similar surgery with Dr. Boachie's? I appreciate any information that you may have. Many thanks.

    Sam

  2. #2
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    sam----------I sent you a P.M.......Ly

  3. #3
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    thanks, lynne

    Hi Lynne,

    I got your message. Thanks a bunch! And I sent you one back.


    Sam

  4. #4
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    could I be in on the loop, please?

    I wish people wouldn't answer interesting questions privately!

    I just consulted my first surgeons in NYC, Though my situation is very different from yours (I'm the patient and I'm 64; also, I only have one son to turn to for any assistance and he's a college student taking time off)

    However, I'm very concerned about finances and would really love to know about estimated costs. If you write back, please let me know what was included - for example, nursing home/rehab care, PT, and follow-up.

    If anyone else can share estimates (clearly insurance is variable) I'd be so grateful. I also wonder about the factors in having surgery near ones home or far, in terms of returning if/when there are problems and for routine follow-up.

    How does one need to be transported and for how long.
    All these questions are intended to reflect average experiences. I know everyone's circumstances vary. (I'm SO sorry for the Nth time I ever moved to this out of the way area in Central PA!)

    Many thanks!

    Amanda

  5. #5
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    Hi Sam...

    You should talk to Dr. Boachie's office. They'll tell you what it will cost. I don't think your insurance will prepay, but again, Dr. Boachie's office should be able to help. Assuming that the hospital accepts your insurance, you probably won't have to come up with much in advance. If you call the finance office at HSS, they can probably give you a good estimate.

    Good luck. Hope you can work it out.

    Regards,
    Linda

  6. #6
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    Hi Amanda,

    I had surgery almost two years ago at age 59. I underwent a 12-hour posterior surgery. I was hospitalized for 5Ĺ days and then spent the next two weeks in a rehab center where I was given a private room and received excellent care. I live alone so rehab was very helpful. From rehab I spent the next several weeks recovering by my brother and sister-in-law who have a ranch house. Since I was using a walker for the first few weeks, my house with stairs was not walker friendly.

    I live about 40 miles north of Chicago so I had access to some excellent surgeons associated with the major teaching hospitals in the city. I had considered a surgeon in St. Louis, Dr. Bridwell, but chose one closer to home. And Iím glad I did. Itís been much more convenient not having to deal with going out of town for follow-up visits, and at three months post-op I was driving myself to my appointments.

    Knowing beforehand that I would most likely incur expenses from this surgery, I put money aside and planned accordingly. I still work and went on short-term disability. I returned to work at four months. My total out-of-pocket expenses were roughly $5,000.

    Hope that helps.

  7. #7
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    to CHRISWBS

    Thank you ever so much!! I'm very heartened to hear of your ability to drive to your three month check-up, especially as your fusion was as long as what has been recommended to me (by two out of there deformity surgeons!) - i.e., T4 - to pelvis. Also, because your age is close to mine.

    Of course, the bit about driving is a little like the old joke about tennis and surgery (pt: "Doc, will I be able to play tennis after my operation?" MD: "I don't see any reason why you shouldn't be able to play excellent tennis." Pt: "Wow, that's great! I never could hit the ball!").

    Having lived overseas for many years where I relied on excellent public transportation, I never quite got the hang of city driving in the US when I moved as an adult.

    But your fitness at that stage of recuperation and age, are great news for me. Truth is, I've been in a state of shock since returning from NYC after hearing from all three MDs (and reading similar on revision threads here) that the average stats for my demographic - say the probability is nearly 100% that I'll need a revision surgery of some sort within ~7 years (will post thread about this soon too.). I've died a thousand deaths since learning that! (What do they say about cowards? )

    The financial news is excellent too, though I wonder about your insurance coverage for post-op care. Mine is pretty lousy. Also abt family back-up. Will send a PM, unless you think your answer would be of general interest (nb. my comment about helping everyone with replies).

    Again, many, many thanks!! Anyone else's input about expenses, would be much appreciated - in line with the original query, that is. Though it was about Dr, Boachie, I think it had relevance to many of us. Besides, I've considered consulting him despite the out of pocket issue. That's re quality of care. (again, another thread is in order - about impact of choice of surgeon on outcome, especially re risks of re-operation.).

    Amanda
    Last edited by Back-out; 03-25-2010 at 11:09 AM. Reason: grammar

  8. #8
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    Exclamation Don't wait for Medicare

    Try to have your surgery before Medicare. It's reimbursements are too low for many scoliosis surgeons.
    Original scoliosis surgery 1956 T-4 to L-2 ~100 degree thoracic (triple)curves at age 14. NO hardware-lost correction.
    Anterior/posterior revision T-4 to Sacrum in 2002, age 60, by Dr. Boachie-Adjei @Hospital for Special Surgery, NY = 50% correction

  9. #9
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    Amanda,

    Not one surgeon of the several I consulted said anything to me about requiring a revision surgery within seven years of my original surgery. My surgeon in fact told me that he wanted to make this a one-time surgery for me. There are occasional instances of an unsuccessful surgery where the patient is faced with the possibility of a revision (two such instances currently being discussed here), but that truly is not the norm.

    Once I left the rehab, I did not require any post-op care other than what help I received from family members. If you do not have a good support system, Iím sure arrangements can be made for some in-home care before leaving the hospital. There are some here who recovered solo, but I would not recommend it for us older folks. Thereís a safety factor that has to be considered. For instance, I was very weak the first few times I showered on my own, and it was reassuring having a sister-in-law ready to assist if the need arose. At two months I was perfectly fine on my own. I was driving and grocery shopping with no problem. I just took it easy. Almost two years post-op, Iím doing great.

  10. #10
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    Karen Ocker and Chris WBS

    Karen: Re remarks about Medicare. I'd thought (and inquired) about this and it is indeed a major consideration. Your highlighting this reality concern is very welcome. Thank you.

    Some "good" doctors accept Medicare, but it seems to be a minority, and I can't help wondering if many don't quite put out their utmost (it's SUCH a strenuous surgery) if that's their reimburser.

    Also, maybe they'd be less apt to "leave no stone unturned" if the patient calling about problems after surgery is a Medicare pt (much less Medicaid). Sad but true (thinking of a case under discussion on these forums)

    Chris WBS, FWIW I consulted Federico Girardi (HSS) and Errico (WHAT a sweetheart!) - he'd be operating together with Frank Schwab - who would accept my insurance as a courtesy to him (Errico). Lastly, Michael Neuwirth. Lonner was out of town, or I'd have seen him too. Debated about Cunningham (HSS) but he was only JUST certified (he's only been in practice for six years). Considering it was far from clear how he'd "work with me about fees" (staff) - from his $500+ out of pocket consult on up, I decided against.

    And as mentioned, I'm still debating about Boachie (even though it would bankrupt me) if it would significantly reduce my risk of repeat surgery....My idea of hell.

    It was Errico and Neuwirth who said repeat surgery was expectable. Errico said "something always goes wrong, small or large", and Neuwirth said the bit about <7years. Of course (lest the rest of you panic, unneccessarily), it's VERY much a function of age and length of fusion.

    The longitudinal studies reproduced here (at least in abstract) said much the same and they're pretty hard to argue with. Only the Lenke study which had markedly better stats on re-operation = even by age demographic. As I recall, Karen Racine commented on it, saying she wanted to look into it.

    I do too! MO is from me, but what the hey, if they're really doing something different (and better) which results in better long term results?

    BTW I do NOT think Dr. Girardi was more sanguine, but rather than he didn't want to scare me.

    I guess I should add my spinal specs as my signature. Let's see if I can figure out HOW (technoklutz ) .

    A. (fearing surgeons or their reps might glance around this site)
    Last edited by Back-out; 04-27-2010 at 04:41 AM.

  11. #11
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    Quote Originally Posted by CHRIS WBS View Post
    Amanda,

    Not one surgeon of the several I consulted said anything to me about requiring a revision surgery within seven years of my original surgery.
    I agree. I suspect Amanda misunderstood something. The reoperation rate is WAY under that, even for very high risk populations.

    --Linda

  12. #12
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    I sure hope so, Linda. Sometimes one really WANTS to be mistaken!

    Wish I could find the studies (at least, one) you referenced on this site, along with your comments there...Was in a revision thread.

    Perhaps. the misunderstanding is between the words "revision" (Meaning a total redo) and "re-operation" meaning ANY more spinal surgery, especially an operation related to the original one.

    I'm quite sure (unless I read in a fugue state! ) that I saw something about the high rates of re-operation I posted, and even surer of what the surgeons told me. Note, that they weren't referring to my anatomy, in particular, though they may well have been considering my age (64) in the prognosis.

    A. (name shortened, as I'm getting sensitive - paranoid? - to the notion that surgeons may read this site)

  13. #13
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    Quote Originally Posted by Back-out View Post
    I sure hope so, Linda. Sometimes one really WANTS to be mistaken!

    Wish I could find the studies (at least, one) you referenced on this site, along with your comments there...Was in a revision thread.

    Perhaps. the misunderstanding is between the words "revision" (Meaning a total redo) and "re-operation" meaning ANY more spinal surgery, especially an operation related to the original one.

    I'm quite sure (unless I read in a fugue state! ) that I saw something about the high rates of re-operation I posted, and even surer of what the surgeons told me. Note, that they weren't referring to my anatomy, in particular, though they may well have been considering my age (64) in the prognosis.

    A. (name shortened, as I'm getting sensitive - paranoid? - to the notion that surgeons may read this site)
    It's possible that you saw something posted by one of the anti-surgery folks. They often reference old studies that have little to do with the type of surgery being done today.

    --Linda

  14. #14
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    Sam....are you set on having Dr Boachie and not another scoli surgeon who does take your insurance...? just asking...

    Amanda...no way is that usual...revision in 7 years...absolutely not expected and i find it strange that a doctor would say that!! it is something most patients ask about (myself included) and that was definitely not the answer i got from any of the 7 plus surgeons i've consulted with...

    re: Medicare...i got it, but have kept my regular insurance...have not switched to a "Medicare advantage plan" as i know several doctors who wont touch that...

    jess

  15. #15
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    Quote Originally Posted by Back-out View Post
    (I'm SO sorry for the Nth time I ever moved to this out of the way area in Central PA!)

    Many thanks!

    Amanda
    Central PA--what area? I feel very fortunate to live in Central PA. We have so many hospitals and doctors to choose from and most are located in a relatively short driving distance. We have Penn State Hershey Medical Center, Danville (maybe), John Hopkins, Philly hospitals plus all the great ones mentioned in NY.

    Mary Lou
    Mom to Jamie age 21-diagnosed at age 12-spinal fusion 12/7/2004-fused from T3-L2; and Tracy age 19, mild Scoliosis-diagnosed at age 18.

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