Planned Surgery Without Obamacare

February 1st, 2017

If you’ve followed my blog, you know I broke my ankle on the 2nd of January. I thought it was sprained so I put off having it checked for two full weeks.  My bad.

I didn’t want to go to an urgent care only to spend a couple hundred bucks to tell me it was sprained, and to just R.I.C.E.  So I just did R.I.C.E. at home, for free.

But then, after two weeks, it was time. It wasn’t getting better at all.  The pain and symptoms were too much, so I may have conceded to defeat, shed a tear or two, and got packed into the van to go to an urgent care.

I’m not here to give you any medical advice, but I want to share things I’ve learned in this latest medical “crisis.”  I have found information very difficult to find, and I believe that no matter what your insurance is, it’s powerful to be informed.

One of my biggest fears/annoyances is paying for a doctor only to have them refer you to someone else.  And that’s exactly what happened. I went to the urgent care where they took xrays. The nurse who took care of me 80% of the time (the other 20% was a P.A.) said “do you want to see the xrays?”  Of course we (my wife was with me) did.  “See that?  That’s obviously a break.”  Ugh… it didn’t look very small :(  “Let’s go talk to the P.A.”

The P.A. basically said “you have to talk to an orthopedic doctor.  We have one in our network…”

That cost $119.

45 minutes later we were checking into another urgent care to meet with the ortho.  He basically said “You have to have surgery.  If it were 2 millimeters separated I like to avoid surgery, but you are almost 10 millimeters.”  I asked “how much do you think this will set me back?” He responded “I don’t know, but I’m guessing between $7,000 and $12,000.”  He gave us a few surgeon referrals to call.

My goodness.

Because we didn’t have the first urgent care put a splint on (because they said we would just have to do xrays at the next place, and I thought they’d just do it there), they charged us an extra $80 to make a splint.  That was a bad choice on our part.

That cost $119 for the ortho to get surgery and $80 to make a splint (that would have been included in the first urgent care trip).

I spent a couple of days calling surgeon offices… that was not fun at all.  But one office stood out, night and day, from the others.  The office staff sold me on using their surgeon, not because they were in sales mode, but because they were very nice (even after knowing I was self-pay, or “pay in cash, before the service”). Learn more about those phone calls, and what I learned for job seekers, here.

On that Tuesday I had made an appointment for the following Monday (which was the earliest they could get me in), and possibly surgery that afternoon, but then I got a call asking if I could come in on Thursday. I was elated to get in earlier.

With the 20% self-pay discount, that appointment cost $200.

The purpose of this post isn’t to be a surgery-log… I want to give you an idea of how I got to a surgeon I liked, and how much it cost.  So far we are up to about $520… just to get referred to the right person, and for him to say “okay, I’ll cut you.” Aside from a splint, so far there’s be no medical care (but hey, the xray and diagnostics is worth something).

$520.

In my experience, a surgery will generate at least three bills: the surgeon, the hospital (or surgery center), and the anesthesiologist.  What do you figure each of those cost?

Four years ago I had emergency gall bladder surgery.  I went into the emergency room at 2:30 am and had surgery a few hours later.  No shopping around.  I was pretty much doped up from 3am until I came out of my anesthetics, with some big nurse over me telling me to “BREATHE!!”

I wrote about the costs here… can you believe that the surgeon, after his 50% off cash pay discount, cost only about $800?  The guy in charge, the guy calling the shots, the guy doing the cutting and repairing… $800.  That seems awfully low to me, especially when the total cost of surgery and ER was over $20,000.  The surgeon’s got less than 5% of the total payments.

Well, here’s how ankle repair surgery came out, for me.  Mind you, this was a “pretty simple” surgery, with two screws and no plates.

Surgery center: $1,305 (after a 75% discount!!)

Surgeon’s office: about $1,400 (I can’t find the exact number, but it was after a 40% discount)

Anesthesiologist: $600 (apparently this was only a discount of $40. I’ve never gotten a good discount from the anesthesiologist)

90 days followup visits with the surgeon are included, although I’ll have to pay for xrays and extras. And I’ll have to have physical therapy, which I’m hoping isn’t more than $500.  Altogether, this misplaced kick-resulting-in-broken-ankle is costing a little less than $3,000.

Not fun, but definitely better than the guess of $7,000 to $12,000.

How might you get an expensive medical procedure for such a low (or “reasonable,” or “affordable”) cost?

  1. You shop around. Let them know you are self-pay and ask if they have a discount.  Don’t argue, just ask. You aren’t negotiating, you are simply gathering information.
  2. Don’t go to a hospital for a planned surgery (if you can help it).  Check out “surgery centers” in your area. This is a MUST READ regarding surgery centers.

Now here’s the interesting thing: After the first frustrating day of calling surgeons the doctor recommended, I called the surgery center and asked them who they work with, or recommend.  That was my short list for calling the second day.

I’m not saying that not having insurance is awesome.  Not at all.  But for those of you who can’t get insurance, you need to know that not all hope is lost.

Oh yeah, for those of you wanting to do the math… assuming I paid $1,000 a month in insurance, with a $10,000 deductible, I still would have had to pay for this entire surgery out of pocket.  Just saying.

2 Comments »

2 responses to “Planned Surgery Without Obamacare”

  1. Jason, Glad all went well w/ your ankle surgery. Hope the rehab PT goes as well. Thank you for posting since very informative.

    I’m somewhat curious to find out whether you’re saying that for you the best you could do for health insurance under ACA is a $10k deductible costing $1k a month. Did ACA not alleviate your situation at all? There has been so much misinformation on ACA, I’m just eager to know your experience.

  2. Jason Alba says:

    Shela, when I applied online for Obamacare I did not qualify for any discounts, the coverage was not good at all (it was more catastrophe-level coverage), and it was simply unaffordable. On top of not being able to pay for it, I get dinged when I pay my taxes for not being able to pay for it in the first place. Not an ideal situation, at all.

.