Hernias and High-Deductibles: A Healthcare Costs Discussion

February 6, 2012

What is more painful: hernia surgery or finding out the exact cost of the procedure when you have a high-deductible health plan?

I apologize in advance. Herein, there may be too much information.

My inguinal hernias are bilateral. The doctor, after guiding me through a turn-and-cough, let out almost a guffaw in his description: “Oh yeah, no doubt.” And that, my blog-reading friends, was before he had even examined the worse side.

Why, you might ask yourself (fairly), am I telling you about the uncomfortable bulges in my nether region?

It is not because I want to describe that I am scared of general anesthesia; very scared.
It is not to wax on about the long list of complications listed on the surgical release, which include all sorts of your-stuff-won’t-work-anymore textual variations. These, strangely, have me more concerned than the you-could-die variations.

Nor is it to dissect the bedside mannerisms of the physician (he wore gloves, answered all my questions), or whine about my now-defunct New Year’s resolution to work out more and get a strong core and better cardiovascular endurance.

No, I’m telling you these things in anticipation of the letters I will write, at some point two or three months from now, asking for financial clarifications and commenting on the healthcare system that is in place.

This will be a healthcare costs prospective investigation.

Here are some basics that are important for you to know: I have a high-deductible healthcare plan, and a healthy dose of medical and health policy knowledge. That means I will be paying out-of-pocket for all services up until my several-thousand-dollar deductible is met, at which point (I think) 100 percent of services are covered.

The amount I will actually be paying is dependent on the contractual agreement between my insurance company and the providers, not the flat charges. This I believe is a common misconception. While the doctor may “charge” $500 for a service, if he is a preferred provider for my insurance company he will accept from me the rate that the insurance company has negotiated and would pay (i.e.: $250). If I were in a traditional insurance plan, I might pay my copay - say, $20 - and then the insurance company would make up the difference of $230.

So, you might assume that when I walked into the surgeon’s office and asked how much the visit would cost me, they would easily be able to pull this value? That would make sense, because then I could - in capitalist theory - walk next door to the competing surgeon and ask the same question, and then make a more educated decision that includes cost considerations.

“Well, we’ll have to check on that,” the very pleasant front office staff said. “Someone will call you in the next few days.”

What to do? Well, I sat back down in the waiting room, and filled out paper forms testifying to my lack of allergies and my lack of prescription medications, and describing that my prior surgery on my leg had been uneventful. I made no fuss, though I’m confident - from the shuffling of papers and a surreptitious phone call that took place - that very few people actually ask the very pleasant front office staff how much a visit costs.

Subsequently, after the turn-and-cough had been completed, my diagnosis rendered, and the need for laparoscopic surgery confirmed, I was back out in the waiting room, filling out more paperwork to schedule a same-day, outpatient procedure.

Not surprisingly: “Uh, how much is this going to cost?” I asked.

Similarly unsurprisingly: “Yeah, we’ll have someone get back to you on that. When would you like the surgery to be?”

My surgery is slated for Monday, February 27. I found it interesting that, even though I was fairly confident for weeks that I had hernias and would need some sort of intervention, the certainty of the assessment and concretion of the surgical date put me in a bit of fog. I stopped at Hardee’s on the way home for a “whoa-is-me” chicken biscuit, figuring that since my aerobic New Year’s resolutions had been indefinitely postponed, I may as well allow myself such indulgences.

But I also accounted to myself that I may as well use 2012, after my surgery, to get myself all medically checked out and spruced up. You see, once I meet my deductible in a high-deductible plan, essentially everything else is covered. Since robotic laparoscopic hernia surgery is definitely going to eat up my full deductible, I have incentive to get that routine check-up and grab labs to look at my cholesterol. Perhaps test Malcolm Gladwell’s theory of “Moral Hazard.”

I’ll keep you updated. One more pre-operative blog, then I’ll let you know how things go - hopefully with all my faculties and valuables in good working order. If Katie Couric can open herself to the world of millions, I figure the hundreds of readers who visit me here are entitled to some real-world insights as well.

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