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Hernias and High-Deductibles: The Quest for Costs Continues


My surgery is complete, I'm resting at home, and still, I have no idea what my procedure costs and what I owe as a patient with a high-deductible health plan.

Today, as I write this, I am post-operative day number three.

The laparoscopic incisions are healing, though the purple hues persist. Especially around my umbilicus, where the inferior bruising is quite significant and residual glue - from closing the wound - has lasted through several showers and my scratching at the area. While I remain a bit bloated, I have decreased my pain med usage. Though I still can’t sit in one place for more than 10 or 15 minutes.

The surgeon said the hernias were quite large, especially the one on the right. He thinks my proceeding with the elective surgery was the right call. He said everything went "perfect." He didn’t comment on my anesthesia anxieties, which I’m sure gave the folks in the pre-op area a good chuckle.

My most passionate appreciation I’ve saved for Lady Luck, who decided not to make me one of the 10 percent with urinary retention, and thus I did not need to go home with a catheter in place.

As of this moment, I have no idea what my procedure costs. To be precise, I have no idea what the surgeon will charge me; no idea what the hospital charges will be; and no idea how much I’ll be asked to pay out of pocket. I have yet to spend a penny.

I did ask. In the hospital, with my father sitting next to me in registration, I asked how much the procedure would cost me.

“Oh, I have no idea,” the lady said through an honest-to-goodness laugh. Very clearly she had never been asked the question before. She did manage to include this statement, however: “A whole lot, I bet.”

Over the course of the immediate 48 hours post-operatively, my father was around to help with little things. As payment for emptying the dishwasher, walking Gibson, and bringing nourishment to the couch, he simply asked that I keep the television on Fox News. We got to talk a lot about healthcare costs.

“I essentially have two practices,” he said at one point. “One is my cosmetic surgery practice, all elective. Every single patient asks me how much the procedure costs.”

My father continued: “My other practice - reconstruction - is insulated by insurance coverage. And people never ask how much anything costs. Never.”

Where does the answer lie?

If, in the registration area, rather than laughing, the woman had told me that my hernia surgery would cost $10,000, would I have had the option to up and leave, and walk to the hospital next door for a second opinion? Should that have been available to her, a big book with all the charges and line items to denote how much it would cost for a person with my insurance coverage?

At on point, in the pre-operative area, an anesthesiologist who I’d just met pitched me the newest latest-and-greatest, a local nerve block injected directly into my abdomen. It helps with post-operative pain control, I was told, and while it wasn’t yet standard of care or routinely being done, it had blossomed out of the academic "research" phase.

All I had to do was sign a consent form. No costs were discussed. I didn’t ask, mostly because I had a splitting anorexia headache from not having eaten in over 12 hours, and because general anesthesia scares me like clowns scare the average 5-year old. I didn’t care to investigate the costs at that moment. Forgive my journalistic faux pas.

I have yet to receive a single bill. Not for the original surgical consultation over a month ago, nor for any of the cutting and pasting that took place three days ago. I anticipate they will soon start to fill the mailbox, first as innocuous EOBs (“This is not a bill”) then with direct requests for money.

I’m wondering how I will prioritize. Because I have a high-deductible health plan, I am responsible for the first few thousand out of pocket and then I am covered 100 percent thereafter. Which bills do I pay first? Do I send money to the hospital for the procedure and have insurance pay the physician professional fees? Vice versa? I’m intrigued to see how this will play out.

Strange, yes, that a physician with a passion for healthcare policy and economics stares at his own medical financial situation with intrigue and uncertainty?

Find out more about Bryan Fine and our other Practice Notes bloggers.

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