Decision on Hospital - recently diagnosed

[Guest]

Hello everyone. I have recently been diagnosed with sever aortic valve stenosis of a bicuspid valve. I came across this forum a couple of weeks ago and have been browsing the many topics. My anxiety has been lessened as I reviewed numerous discussions on my condition. At this point, I have had a confirmatory esophageal echo done and have been informed that surgery should be scheduled for early January. Now I am beginning the search for doctors and facilities. My first choice would be the Cleveland Clinic, but they are an out of network provider for my insurance. I live in Buffalo, NY and have two local hospitals that are in network but are not as highly regarded. What are your thoughts as to how I should make the determination on Dr/facility.

 

[Patrick7651]

Sorry, I was having difficulty posting and I showed up as as guest user.

 

[pellicle]

Hey Patrick
As an Aussie in Finland I can contribute nothing on your hospital choices, I just wanted to say welcome , wish you well , and hope that as you read more here your anxiety will ease even more

 

[AZ Don]

US News has rankings on Hospitals here: http://health.usnews.com/best-hospitals/rankings/cardiology-and-heart-surgery
They also have a useful search option but it appears to be broken at the moment (only returning results < 25 miles).
and there is another website with Hospital safety rankings, here: http://www.hospitalsafetygrade.org/
My view is that heart surgery is not something that you want to have just anywhere, but generally a good regional hospital can do a fine job and it is generally not necessary to travel significant distance (or out of network). This is a personal choice. You can look up information about your local hospitals on the US News website to see how they compare. If you want to go to a top Hospital, Columbia Presbyterian is #3 for Cardiology and in your state so perhaps in network, though it is probably farther from you than the Cleveland Clinic.

 

[Patrick7651]

Thank you for the welcome. Continuing my research on hospitals and insurance. The Buffalo area hospitals do not rank in the US News ratings and they are lower in safety ratings. In confirming with my insurance company, I am looking at $5000 max out of pocket for Cleveland. I am leaning towards the peace of mind that they can to provide. It's a lot of money but this is not knee surgery. Columbia is out of network also as my insurance only covers western NY.

 

[AZ Don]

$5000 out of pocket sounds like a good deal. I paid more than that for in network surgery. The thing about out of network that you have to watch out for is if you could also be responsible for the difference between Cleveland Clinic rates vs. your insurance companies rate guidelines. They call this balance billing:

[FONT=&quot]Balance Billing - Balance billing is a type of healthcare billing that occurs when an out-of-network provider bills a plan member for the difference between the out-of-network provider's charge and the amount paid by a member's benefit plan for the out-of-network service, and this difference exceeds the member’s defined liability from the Plan. This means that if the defined out-of-pocket for the member was 20% of the provider’s charge and the member pays more than 20% - not due to a deductible application – this is a balance bill. This situation happens when a provider does not participate in a member's provider network.[/FONT]

Cleveland Clinic probably has people that can help you sort this out. There is no better hospital for heart surgery.

 

[Patrick7651]

I spent some time with my insurance provider and between my deductible and out of pocket max she assured me that regardless of the 20% co-insurance i would only have to put out $5000. I will contact Cleveland tomorrow and verify that this would be the case. If it is, I think they will be my choice.

 

[Marie-62]

Hi I am in the wartting room, I am going for my echogram in January. I am also in Buffalo New York. What about Gates Vascular Institute. I came up with three surgons . Dr. Janerio Aldridge, Hashmat Ashraf, and Gary Grosner..I have Aortic Stenoisi. Check it out, and you can get back to me.

 

[Marie-62]

I would also mention to you on Adam Pick website that these doctors were mention. You would put the zip code of were you live and two of these doctors will come up. I also had friends of friends that had heart surgery at Gates Vacular and they were pleased. I guess I have been doing my home work, to see what is out there. Plus these people are great here. It a great room.

 

[Patrick7651]

After doing some research on my local hospitals compared to the Cleveland Clinic, I guess the decision comes down to "Do I have access to THE best facility for an aortic valve replacement?" Although the area hospitals are capable and proficient, Cleveland is THE best. During a very enjoyable Thanksgiving dinner last night, I spoke with with my sister-in- law who is a nurse and is very knowledgeable in local medicine and doctors. Her nugget of wisdom to me was "Cleveland is where the cardiologists and their families go for these procedures." That puts my decision into better perspective. Although logistically difficult, It comes down to peace of mind and having the absolute best care available for me. This is a very scary point in my life right now and at 49 I have two girls, 10 and 8 years old. I plan on being around for a long time to come.

 

[Marie-62]

I agree this is sacry for me to. Not telling you I had open heart surgery 41 years ago in Buffalo Back then there was no web site, just talking to the doctor. They came a long way from then..I know how you feel. I wish you the best and I will pray for you. I just retired and found out I have a valve problem. But, I hope you check out Adam Pick you can google it. I just been doing a lot of research, some time to much. Prayers be with you.

 

[epstns]

Patrick, if you have the financial ability to choose, and if there is no "Center of Excellence" hospital any closer, then I would opt for Cleveland. Have you checked, though, to see if there is a nationally ranked heart hospital any closer that might be in-network for you?

I do know, though, that most group health plans have not only in and out of network rates, but they also have an annual out-of-pocket maximum amount for each patient each year. If you hit that before you hit the co0insurance amount for your trip to Cleveland, then the out-of-pocket maximum would be your exposure. It may be worth a call to your insurance administrator to see how all these formulas interlock for your particular case.