Anyone beside me having issues with the Cleveland Clinic? Cancelling my surgery

[carolinemc]

Can you travel for surgery ? perhaps to india

Poor people have no money to travel to other poor countries.

 

[BillDaThrill]

Sorry KarenK about your troubles with Cleveland. My experience there for my surgery, both medically and financially/administratively, was wonderful. Hope all is resolved and the CC will work out for you.

 

[ashadds]

Poor people have no money to travel to other poor countries.

whats the cost of travelling ? its around 2k $ , whats the cost of surgery its 10 times at 200 K. It looks reasonable to a lot of people, poor people dont have money for surgery but most of them have money to travel and get the surgery at 1/10th the cost

 

[Dodgy Ticker]

No pun intended, but my heart goes out to you folk in the US.... Its so unfair. From my side I had to make a critical decision to stay living in France precisely because the medical is free. For the moment, whilst my kids are growing, this is indeed a pleasure, but I had no intention of staying here forever, however the needs of my health now have to take a priority, as if I don't make the right and intelligent decision - as opposed to the preferred one - then I wouldn't be around to be a father for much longer.

The utter irony of it is, if I had the choice of where to spend my retirement, it would be in the Mojave Desert of all places - PRECISELY the country you guys are having such issues with!!

You just HAVE to make the tough choice in these kinds of matters - even if it isn't desirable or convenient. I wouldn't have chosen to spend the rest of my life amongst the ever-negative, grumbling, protesting and bleeding-heart French, but - well, its either THAT or taking a risk too far...

I wish you well and success!!

 

[Superman]

Terrible....gotta love the state of healthcare in this country (not!). Don't get me started. Sorry for your hassles. I've been through similar things on a much smaller scale though.

Curious. Do you think with National Health Care systems in other countries that you’re allowed to shop around for only the best providers without having to pay out of pocket?

Wondering if any of our Canadian members (or other international members) can share perspective? Are they assigned a hospital for example?

Frankly it doesn’t surprise me at all that an insurance company wouldn’t want to pay for nothing but the best, when it is a fairly routine procedure these days. I had both mine done locally without issue.

When insurances pay for nothing but the best, we all pay for it in the form of ever increasing premiums and deductibles.

 

[jtf2]

I can can only speak from my own experience,for my ohs i had in August.I live in Saskatoon Saskatchewan Canada.
Bigger cities could be different,but do not know.Royal University Hospital was where i had my surgery,only because that is where the cardiology department is located.Heart surgeries are done only at ruh,not the other 2 hospitals in the city i live in.

 

[carolinemc]

whats the cost of travelling ? its around 2k $ , whats the cost of surgery its 10 times at 200 K. It looks reasonable to a lot of people, poor people dont have money for surgery but most of them have money to travel and get the surgery at 1/10th the cost

LMAO. Poor people do not have $2,000 to spend on airplane trip or surgery in a foreign country. We poor people are on limited income and we have Medicaid and Medicare to cover our Health issues. I do not travel overseas or even in the USA for I live on limited income due to my health issues are considered Disability and cannot work.

 

[KarenK]

I've been to the CC twice. They are the best for your required procedure. They are also significantly less expensive overall as compared to any other large facility (in NA) in my experience. They provide one comprehensive bill. You will not receive separate bills for services. All service providers are employees of the CC, not independent contractors.
Your fight is with the insurance company, not CC. As this is required surgery, I say go forward with the CC and deal with insurance separately.

When were you at the CC? Absolutely nothing you said describes the CC today. The CC's documents states "providers are NOT contracted with or employees of the CC" and you will received separate bills for surgeons, radiologist, anesthesiologist, pathologist, etc. as well as for services eg radiology, laboratory. And $450k+ is less expensive?! At this point I don't know that I can deal with the insurance company on the backend. Federal regulations may not allow that and the CC had failed to with appeals on the front end, I wouldn't count on their support on the backend. I would prefer not to have years of battling this in my future. $450K+ is significantly less expensive then any other large facility???? What are you smoking?

 

[KarenK]

That's scary. You didn't say what insurance you have. I'm guessing you don't want to name them for fear of retribution. I'd appreciate who and what type of insurance. If you send me a message that's fine and I won't say anything.
My company is trying to force us on their preferred plan. It's either that or no medical. I'm seriously concerned that exactly what you're dealing with will occur.
Good luck and TIA.

The insurance is Humana Choice PPO Medicare Advantage Plan. Actually I have been remiss in not stating more often who the ins. co. is so others hopefully do not fall into the same situation. United Healthcare is just as bad, worse in some ways and I think they are the largest insurer in this category. There really are no good Medicare Advantage plans. Those that love theirs haven't had a major health issue but that day will come with age and they won't be loving to anymore.

 

[Unicusp]

When were you at the CC? Absolutely nothing you said describes the CC today. The CC's documents states "providers are NOT contracted with or employees of the CC" and you will received separate bills for surgeons, radiologist, anesthesiologist, pathologist, etc. as well as for services eg radiology, laboratory. And $450k+ is less expensive?! At this point I don't know that I can deal with the insurance company on the backend. Federal regulations may not allow that and the CC had failed to with appeals on the front end, I wouldn't count on their support on the backend. I would prefer not to have years of battling this in my future. $450K+ is significantly less expensive then any other large facility???? What are you smoking?

I was there 2 years ago. One bill. Total was in high $200's. I recall a 6 day stay.
I doubt that they fired all employees and changed to a contractor model.

 

[KarenK]

I was there 2 years ago. One bill. Total was in high $200's. I recall a 6 day stay.
I doubt that they fired all employees and changed to a contractor model.

The estimate I received only included the surgeon and no one else. Others to bill independently, don’t know who the are, nor if they take my insurance

 

[Croooser]

Similar to Unicusp.

 

[ashadds]

perhaps CC has changed, curious to see how my future consults with them will go

 

[Unicusp]

View attachment 889642The estimate I received only included the surgeon and no one else. Others to bill independently, don’t know who the are, nor if they take my insurance

The above is worded like standard contract language to cover them in case a non-employee/contractor is involved in the procedures. They can't predict that a special case may occur. Funny you mention the physician charge. That was one of the lowest on the bill, a couple thousand dollars. Room charges and surgical suite were the highest. I recall when I was looking at costs, my closer UPMC facilities (in Pittsburgh) were estimating double what my final bill was at CC. I had great full insurance coverage my entire life until a year before this surgery when I was downsized from Corp life. Had to go on my wife's terrible and very expensive very high deductible plan from a small employer. The annual cost of premiums are very high but lower than the insane cost for ACA insurance. But, in the end, what choices do you have? Have the life saving surgery at any cost, or die pretty quickly with money left-over. Your choice. My aortic valve went to severe very quickly within a matter of a few months. They told me I had an estimated 3 months. I was able to get in quickly with the best surgeon there (in my opinion!) Dr. Svensson, who did my first surgery (ascending aorta replacement) 7.5 years earlier.

 

[Lynn]

Reading the experiences of US posters here, what strikes me is the massive administration burden placed on hospitals and patients. Fighting to get every test and procedure approved for insurance coverage prior to, must be frustrating and exhausting.

I live on the West coast of Canada and we don’t have that hurdle, if your doctor says it is medically needed, you get it. If It Isn’t emergent you may wait longer than you want, the system is by no means perfect, but my experience is you get what you need. And you are not billed for anything in hospital. Maybe a TV in some hospitals lol. Surgery is stressful enough with out worrying that it will bankrupt you so I am grateful. There still be some costs, drug Coverage is means tested (a Higher income means an higher deductible for drugs but most of us have a plan for that through our jobs)and peri medical like massage and physio are not always covered.

One of the draw backs is less choice to pick your Hospital or doctor. You are pretty much stuck in your home province as each province administers their own health care, though all must provide care to the same general standard. I live just over an hour from one of the best heart hospitals in the country, so for me it wasn’t a problem. If I had wanted to have surgery in a different hospital, I think my cardio would have obliged by referring me there, but I would have had to travel and maybe wait longer.

I think it’s also more challenging in smaller and remote communities to get quality care and needed diagnostics. Canada is a large country with a small population it can be challenging to service remote areas to the same standard.

A question for American folks; is the CC really that much better, or is it hype and marketing? There must be tones of other great hospitals and surgeons in the country? Though if I lived in Arkansas, given their ranking, I would also be concerned.

Our system faces challenges for sure and it’s never prefect and it does result in higher taxes. I can see Americans have more choice and may not wait as long as Canadians, but on balance I wouldn’t trade you. I just can’t imagine having to make health care decisions for my family based on finances Instead of need.

 

[MIB]

The insurance is Humana Choice PPO Medicare Advantage Plan. Actually I have been remiss in not stating more often who the ins. co. is so others hopefully do not fall into the same situation. United Healthcare is just as bad, worse in some ways and I think they are the largest insurer in this category. There really are no good Medicare Advantage plans. Those that love theirs haven't had a major health issue but that day will come with age and they won't be loving to anymore.

I'm sorry you decided on an advantage plan. They're not good if you have health problems. This of course is my opinion.
I refuse to let an insurance company dictate my health care.
I suggest you contact your state insurance commission. I've never heard of denial of this type of procedure.
It looks like they're attempting to bill as self pay.
Something isn't right.

 

[V__]

A question for American folks; is the CC really that much better, or is it hype and marketing? There must be tones of other great hospitals and surgeons in the country?

It may be hard to get a precise comparison from a personal experience, I'm afraid. An accurate evaluation has to be based on statistics...

When looking at my options pre-surgery I did find some cues though:

• CC has been top-rated for a couple of decades
• They are so popular that there is this fly-in-for-the-surgery program
• They are so popular that there are CC clinics in other places (Florida, London UK, Abu Dhabi)
• They are early technology adopters (e.g. "robotic" surgery)

The "popularity" has the consequence of handling a very large volume. E.g. the original Cleveland site does 5000 surgeries per year. For complicated surgeries this is a very good sign. It means that they "polished the process" very well. For both aortic and mitral valve surgeries there is risk-vs-volume curve, where the risk goes down continuously. This makes sense, of course, since "practice makes better". Given the total cardiac surgery volume in CC, they can get to very large valve volume as well (probably hundreds per year).

All that said, your point about many other locations being good is valid. The risk reduction for very high volume seems to be just a fraction of a percent compared to an average volume center. (At this point, the valve surgeries are very well understood and controlled.) When I realized that, I stopped thinking about other alternatives and instead just scheduled a surgery at a local place as soon as possible. Figured that the possible delays with finding another location and traveling would add more risk than I may hope to gain by changing the location. (And I really liked my surgeon.)

 

[V__]

The above is worded like standard contract language

Some of which can look quite worrying if one actually reads it. I recall signing a waver before a colonoscopy, when my wife's face changed and she left the room. That looked more worrying to me that the actual procedure. Of course, it turned out that she didn't like the waver language about absolving the doctors of any problems. But it was a standard legalese for a very routine procedure.

 

[Superman]

Some of which can look quite worrying if one actually reads it. I recall signing a waver before a colonoscopy, when my wife's face changed and she left the room. That looked more worrying to me that the actual procedure. Of course, it turned out that she didn't like the waver language about absolving the doctors of any problems. But it was a standard legalese for a very routine procedure.

At least in the US, you sign the waiver, something goes wrong, you sue, the waiver doesn’t hold up, you win the lawsuit. None of which makes up for a perforated colon. But still.

 

[slipkid]

At least in the US, you sign the waiver, something goes wrong, you sue, the waiver doesn’t hold up, you win the lawsuit. None of which makes up for a perforated colon. But still.

That almost happened to me (perforated colon). Long story.

But you're right about suing anyway in these cases.

If things go wrong regardless of a waiver you (or your heirs) will win in court (or through a settlement b4 trial) anyway. My best friend was killed by an inexperienced DR doing a "routine" sinus scraping procedure to clean gunk out in there (I 4get the name of the procedure). We learned later she had only done the procedure like 7 total times; lesson learned there is to check your Dr's experience and try to go with someone that has done whatever it is hundreds of times therefore hopefully knows what they''re doing and hasn't killed anyone - at least not lately.

His wife sued and settled for $7 million regardless of any pre-procedure waivers. The $ don't make up for ending his life, ruining hers, or the multiple ripples his shocking death caused the rest of his family and friends like me but....at least his wife (and her lawyers) got to split $7 mil. The lawyers make out quite well in these cases without even suffering the heartbreaking losses and the Dr? Well it was a settlement and as usual with such arrangements they admitted no wrongdoing as part of that so I have no idea even if it goes on their track record for anyone to see in public later though.