Self Pay "extras"

[Sooz 0]

Last week I went for my consultation/physical with my surgeon-to-be and was a bit rocked by the amount of tests ordered. I suppose I should have asked for more details beforehand, but when it was described as a "physical" I assumed some things like EKG and stress tests would be done right there. I also thought that some of the tests (like psychiatric) mainly applied to those with insurance requirements. I hate the thought of spending whatever 90 mins with a shrink costs simply to be deemed "sane", you know?

Here's what I have to do before I get a surgery date:

• sleep study for suspected apnea
  
• Abdominal ultrasound
  
• Chest Xray
  
• EKG, Pulmonary function test, pulse oximetry
  
• EGD outpatient (upper endoscopy for acid reflux related symptoms)
  
• Blood and lab work-up
  
• Internal/Family Physician written consultation and clearance.
  

I haven't had a "family doctor" since mine retired some years back.

[LeighaMason 19]

All my tests were included in the price of my surgery. $10,200 out the door with 6 months of fills included.

[Sooz 0]

Wow, I wish I got a deal like that, Leigha.

My surgery fees total $14,450.00. - $4500 surgeon, 1150. surg assistant, 7,700. medical center, 1,100 anesthesia -

and includes 3 mos aftercare w/ 1 fill.

I was just wondering if what I posted is the standard battery of tests most people have to take care of prior to getting a surgery date.

In the meantime, I got some very good news. I have so-so insurance, also self-pay, and I called today to find out if any of these procedures were covered. I was told $500 ded for the year and then they will pay up to $2000 per day for the studies. I think that will cover a decent chunk.

[LeighaMason 19]

Oh thats cool! Be sure and submit everything after the surgery as well. I had a surgery on my foot once that my insurance denied up front so I paid for it and then I submitted it and they reimbursed me for the whole thing. Even if they pay for some that would be good.

[bevanfranks 0]

I wasn't required to do a sleep apnea test, etc.

I had to meet w/the nutritionist, have a basic physical, and do the psychiactric eval, but it was no big deal. These things were covered in my surgery cost of $18K.

That also includes a 1 1/2 year warranty if I have to have another surgery.

[Windus 0]

I don't know if you have considered it but I went to Cancun and had my surgery. The surgery cost $5900 total. I went almost a week early to have a vacation and even with the airline tickets, the hotel room, all my vacation stuff, etc. I paid our less than $7000.

[Kristy29 0]

That sounds about right. I am in pre-op now. So far I have met with a cardiologist, who did an in office ekg, and then I had to go to another office for an echo and a stress test. Had to get clearance from my pcp, a psych eval, an upper gi xray, an egd, and 3 months of meeting with the nurse practitioner and the dietitian. The only thing you are doing I'm not is the sleep test.

I would rather do all the required testing, than not do it and run into complications during surgery.

[steph_co 9]

Wow. I didn't have to do all of that. I paid somewhere in the neighborhood of just under $11,000 - but it covered everything, plus 1 year of fills. It's been 2-1/2 years, but I only remember meeting one-on-one with a nutritionist and a Nurse Practitioner. Between the two, they answered all my questions, and did like an interview-type thing to make sure I wasn't bulimic and had realistic goals. I don't remember a psychiatrist/psychologist.

But as for all the other tests - the only one I had was a blood draw right before the surgery so they'd have all the info about my blood.

[Sooz 0]

Kristy you are absolutely right. I haven't had any sort of physical in years and it's time. I want to do this right, especially since I have been feeling terrible and unhealthy lately.

[BetsyB 9]

Don't you think the physical and emotional health of the self-pay patient should be as thoroughly examined as that of the insured?

Insurance companies don't require it for fun and games--it costs them more! They require it because the outcome of the tests helps ensure SAFE surgeries.

You need to get the same clearances to be sure YOU will be safe. No matter what the mode of payment.

You may find that you get pulmonary clearance without apnea testing (I did), and cardiac clearance based on history and EKG alone. It's really up to the specialists; your surgeon sends you their way, and then it's in their hands.

[Windus 0]

No, I think that in the US there are far too many useless and redundant tests done. Frankly I think it is more for cover your ass insurance for the doctor then for a real need for the patient.

I had an EKG, blood work, x-rays, physical and all that in MX prior to the surgery. The only difference was they did all of it on the day of the surgery.

I didn't need a "emotional" or psychological workup in order to know what I can handle. I am all grown up and know myself pretty well.

[Sooz 0]

Don't you think the physical and emotional health of the self-pay patient should be as thoroughly examined as that of the insured?

Insurance companies don't require it for fun and games--it costs them more! They require it because the outcome of the tests helps ensure SAFE surgeries.

You need to get the same clearances to be sure YOU will be safe. No matter what the mode of payment.

You may find that you get pulmonary clearance without apnea testing (I did), and cardiac clearance based on history and EKG alone. It's really up to the specialists; your surgeon sends you their way, and then it's in their hands.

I didn't realize the tests were required by the insurance companies to ensure safe surgeries. I honestly thought some of them were done in case the insurance companies were hedging, and the doctor hoped to find co-morbidities (especially apnea) to help the case seem more a medical necessity.

I am incredibly grateful that my sub-par insurance is paying anything at all towards the testing. I've gone from a robust obese person, to hobbling around and feeling crappy in a very short amount of time, I'm happy to finally be doing something for myself.

[Humming Bird 275]

I had no pre-op tests ...... zero.....nothing.

I paid $9950.

[Sooz 0]

It's been quite a whirlwind of testing and doc appts this month.

My bloodwork showed low vit A and D and low Iron. Because of the low Iron and my age (over 50) my doctor ordered a colonoscopy as well.

so-

6-18-10 physical with GP including EKG

6-21-10 endoscopy (showed a bit of erosive esophagitis and a hiatal hernia)

6-22-10 colonoscopy

6-23-10 chest x-ray and abdominal ultrasound

still to go:

1) Pulmonary function test, pulse oximetry

2) sleep Study

3) Psych appt

plus a couple of extras the GP threw in - mamogram and bone density study.

I am ready for the sleep study right now.. lol. Or at least a nap!

[JudyDF 0]

Wow what insurance company do you have? That is really cheap. I have Qualcare plus I work for a hospital system and my bills came to over $20,000. Ofcourse I didn't have to pay that amount but I never heard of anyone paying the amount you did unless they went to Mexico.