Way back in 1999 and 2001, I went under the knife, both times for hernia repair operations. Going in for surgery is never fun, but looking back, I'm amazed at how little I thought of the cost of health care in terms of what was a priority and everything else.
The First One: I Didn't Even Know What Was Wrong
When I had my first hernia, I didn't even know what I had. For those who aren't sure of the exact problem, it's essentially a tear in your inner lining that typically keeps your intestines in place. I had a ballpark idea of what a hernia was and I knew how the doctor tested us guys (yes, we do turn our heads and cough), but I didn't know why I had this big lump that appeared at the bottom of my stomach, and why I could push it in and have it pop out. It didn't really hurt, it was just…weird.
So, I scheduled a visit with my doctor and just by looking at it, he was able to tell me that I had a hernia, and referred me to a specialist.
The specialist confirmed the diagnosis and said that I would need surgery. They'd have to cut me open at the spot of the hernia and patch the hole. This was done via a type of mesh. In the old days they would actually sew you up on the inside, which I guess hurt a lot and it also wasn't very reliable. The mesh solution allowed for more flexibility and movement which would reduce the future chance of tearing.
At that point, all that came out with health care was providing my insurance card to make sure that the hospital and specialist (who was the surgeon) would cover it. I had no idea what it would cost total or what my out of pocket was.
Even the day of the surgery, I really had no clue. I filled out the paperwork, got ready for the surgery, and went in for the fix. It was a little daunting because it was at a hospital and the surgery area was huge, and there was just a lot of hustle and bustle. The surgery was the type where they had to do a full incision, and for any ladies who have had a c-section, you can relate that cutting through your abdomen is painful.
Really painful. It hurt a LOT to walk and move around, even with the pain medication. I had arranged to spend a couple of days at my parents for recovery time. The healing was slow, and after a couple of days I did go home, and a couple of days after that I went back to work, though on a very light schedule. As it turns out, I probably should have stayed out for longer than I did, as I went through a lot of pain in those first few days.
Eventually, things got a lot better and after a couple of weeks was largely pain free.
Until the bills started coming.
I have no idea what the costs were, except that my final cost was around $700 out of pocket. Before that, I had no idea what to expect.
Still, I remember looking in awe at what the hospital billed the insurance company, and was also shocked about how much of a lower rate they actually received. The $700 hurt, but I was enlightened by my first real exposure regarding an ‘Explanation of Benefits'
Round Two, When Everything…I Mean Everything….Was Easier
The hernia I had above had happened on my right side. The surgeon had warned me that in cases like this, it was fairly common that whatever the conditions were that led to the hernia on one side likely existed on the opposite side of my body, and that another hernia would be possible. Sure enough, I felt the familiar feeling of my intestines not being exactly where they should be.
I once again called my doctor, and he didn't even want to see me! He knew that someone who had a hernia once would recognize the symptoms, and since my insurance didn't require a referral, he just advised that I go right to a surgeon.
This was a couple of years later, and I decided to do a little checking. Research told me that there was now a laparoscopic method of hernia repair that was much less invasive and would therefore be less painful. Instead of doing a full incision at the point of the hernia, they would do several tiny incisions at a couple of different points. One of them would allow for a small camera to be placed in, and others would be for the instruments to go in and the mesh to be fed in. At that point, the surgeon could do the work by looking at the camera.
It sounded really good to me. I did some research to find a surgeon in the area that participated in my plan, and went to see him. I actually spent a great deal of time talking with him, learning about the procedure, and understanding his background since it was a relatively new process in hernia repair at the time (it's now the routine method). He said that the biggest risk was that if the hernia was bigger than originally thought or in a location where the instruments couldn't go through, they would have to do a full incision anyways, in which case you actually have more pain because you have the full incision plus the other little ones. Still, he felt that with what he found with mine, that the risk of this would be less than 10%. Those were odds I was willing to take.
So, I was on the track for less pain, which I loved. I also found that he scheduled it at a surgery center versus a hospital. A surgery center is a standalone building that is dedicated just for surgery. It was so much easier to handle. It was lower key. You went in and it was barely a few steps until you were where you needed to go for prep (versus the maze of getting through a hospital to the surgical area). Same with getting out. From the recovery area to the door where my parents car was waiting was literally less than 100 feet. Try managing that at any hospital.
The first day when I got to my parents house, I was awaiting a lot less pain. And, it didn't happen. That first day, it hurt just as much as the first day it did for the original surgery. I was mad and cussing the doctor out quite something. On the second day, when I woke, though, is when I felt the difference. I practically hopped out of bed. It was at that point that I knew the laporoscopic method really did result in less pain.
So far an easier surgical experience and an easier recovery. It couldn't get any better, right?
Except in this case it did. I had set aside a similar amount of money anticipating the bills to come where I would need to pay the $700 or maybe more.
The bills never came.
In fact, the explanation of benefits came and showed that I owed exactly nothing.
This was amazing to me and I even called the insurance company, and they confirmed it.
I found out years later that I was the benefit of an office manager that had kind of taken advantage of his position and used it to help his personal situation. He had a large family, I think six or seven kids, and thus there were a lot of doctor visits and such. He was also in charge of working to set up our insurance plan, and somehow managed to negotiate a plan that lowered out of pocket costs to virtually nothing (or in many cases, as I found out, exactly nothing). It must not have been noticeable up front to the owner, because it took a couple of years until the owner had to tighten costs, so he let the office manager go, and started reviewing all of the costs. He quickly reverted to the plan that was less costly for him and would put co-pays back in line.
(Note: This is all the story I was told by a co-worker who remained there. I had left the company by the time this discovery was made. So, things could have and probably did transpire differently. I'm just relating what I was told.
I was lucky enough to be the recipient of that year or two window where the office manager may have…taken some liberties, but it introduced something else I really knew about health coverage (but have since really learned), which is that some of it is really good and some of it really sucks.
Since then, a lot has changed. Thankfully, I have had no further problems with any hernias and I've not had to go under the knife for anything else. I have had a lot more interaction with the ins and outs associated with health care, and I'm sure that's going to be the case for the rest of my natural life. I did learn that pays to be educated…both about health care and about hernias, of course!