Why I changed doctors and am heading to another state, from a self pay patient

I thought I'd share my thoughts and concerns as a self pay patient that anyone who's at the research stage might want to consider and why I decided to change doctors and head out of state.

Originally I met with and scheduled surgery for the end of November to have the sleeve here in Boise, ID at St. Luke's.  They're the big hospital around here, and the doctors are the most experienced in the state.  For anyone who doesn't know this already, Idaho doesn't have a huge population.  So St. Luke's is your go to place if you want to have any gastric surgery.  But I was also considering having it done at St. Mark's in Salt Lake City with Dr. Smith from Rocky Mountain Associated Physicians, 5 hrs drive away from Boise.

Since it was scheduled at St. Luke's for the day before Thanksgiving, my mom would not be able to get the Black Friday weekend days off work to come up from California and help with taking care of me and my son.  My husband would have to take time off work for that and his work also may have issues with giving him the days off.  The 3 doctors at RMAP have SO much experience, more than the doctors at St. Luke's.  They're also a Center of Excellence.  So why drive?  Well... as a self pay, cost is important.  I found the surgeons fees as a cash patient with RMAP was double what the surgeon's fees are here at St. Luke's BUT the hospital charges were less than half!  There is a $12,000 price difference in hospital fees.  I don't know about you, but I don't have a spare $12,000 lying around.  I'm using a combination of savings, credit, and help from family to get this done.  I had a difficult time getting an explanation of why St. Luke's charges so much more than having it at St. Marks 5 hours away.  (basically, I did not get an explanation at all, just told they are a center of excellence as well and have specialized equipment).  I was told by RMAP's office that they have a great contract with the hospital, and from what I gather, it sure looks that way.

Even if I was willing to pay the $12,000 MORE to have it close to home, another major cause for concern was the "facility cap charge limit".  At St Luke's, its $36,000 for the sleeve.  At St. Mark's, its $100,000.  That's a HUGE difference.  What if I had a complication during surgery that required a few extra nights in the hospital?  Or a leak that needed to be fixed?  How much would it cost me at St. Luke's then??  It costs more up front, and more on the backside if I had a problem during the initial surgery.  I know if I have a complication a few weeks out (or basically anytime after I'd returned home), it would be easier to be a patient at St. Luke's.  We ultimately decided it would be best to pay whatever it costs to be seen/diagnosed here IF I should have a complication post-surgery, and IF it could wait 5 hrs to fix, then we drive or fly to Salt Lake to be treated Dr. Smith.   If its not related to surgery, then my health insurance should cover it.  Bottom line- the cost to handle a complication would still be less than going to St. Luke's, however we handle it.  IF IT HAPPENS AT ALL.  I have to stress that I'm not a gambler hoping nothing will go wrong; I'm a planner and I need to know what ALL the costs are including those that could come up if everything does not go according to Plan A.  It could be financially devastating if I've maxed out what I can spend on the initial surgery and then have a complication that results in a few extra nights at the hospital at St. Luke's.  In SLC, not nearly as likely to be financially devastating in that same scenario because of the much higher cap limit and lower up front cost.

I'm not concerned about distance and follow up appointments at all.  I don't mind hopping in the car every so often (or taking a flight) to see my doctor.  Again, we're talking about $12,000. 

Lots to think about!  No insurance hoops to jump through, but definitely lots to think about.  Affording the initial surgery cost is huge, but the cost beyond that is VERY important to think about as well, especially for those considering travel.   I am super excited and glad that I "shopped around" both in state and out of state. 

I'm in the initial stages of getting insurance approval. I agree with you even if a person has medical coverage most still need to pay the 20% which could be huge differences. I've been considering out of state options if need be but like you I worry about any possible complications and all the after care visits. I'm sure we will make the right decision for us in the long run. I figure if I go 3 or more hours away I will stay in a nearby hotel for a week. .. get my week check up then head home. I was watching sometimes vlog on you tube and she went to Mexico. I guess at that point I would think about s mini vacation; good luck to you.

I seem to remember something about a one off insurance product you can buy to protect you in case of complications. I think my surgeon offered something but I turned it down if he did. I was self pay too. Maybe someone else will chime in with some information.

I got an all in price of $13,800 whi*****luded everything from the doctor and the hospital (two days if needed) including the gas passer and they were a center of excellence.

 

There is an insurance for self pay. It is called BLISS. Talk to your surgeon about it. Also, if you want to travel to Oklahoma you ca get a better rate and excellent care.