My 20 year son does not currently have medical insurance. He has an issue where his throat closes up over time and it makes it difficult to swallow and eat anything unless he cuts it up into very small bits. Docs are not sure what causes it. May be acid reflux issue, but he does not seem to have any other acid reflux symptoms. It’s some sort of ring structure at the top of his esophagus that contracts or gets thicker or something.
Approximately a year ago he had a procedure while on ex-wife’s insurance (he was a student at the time) where Doc gave used some sort of tool to go down his throat and stretch open his esophagus. IIRC there might have been some kind of balloon involved. They put him under to do this. He also gave him some acid reflux drugs and he (I think) he took them, but they ran out a while ago. Although I took him last time the cost was billed through her (not that great) Sears insurance. Ex does not remember the retail cost for this procedure, but she thinks it’s in the thousands. I can’t imagine it would be that much.
Anyway the current scenario is that he needs this procedure again. He lost his student option to stay on her insurance. I’m not sure what the procedure is called. It was performed at the endoscopy center. I someone has to pay for this procedure out of pocket what is the likely cost? I’m assuming it’s procedure + anesthesia.
As side note, does he need to be anesthetized for this?
I can’t help on the cost front, but it sounds like a Schatzki Ring or Esophageal stricture- I’ve got a Schatzki ring (along with my hiatus hernia) somewhat lower in my eosphagus, but I have never needed treatment for it. The procedure will have been a endoscopic balloon dilation. There are some other options, but you will need a doctor to advise on the appropriateness of these.
The drugs used to control acid reflux (proton pump inhibitors, usually) are pretty cheap, and available in generic form.
I hope your son finds a treatment option you can afford. I have very occasional episodes, I would hate to suffer regular and ongoing problems, and certainly not at 20.
I’m thinking $2,000 for the operating theater, $1,000 each for the doctor and anesthetist for a total of $4,000. Again, this is a wild guess where I would start. It’s bound to be more or less for each factor, but maybe average out in total.
$4000 may not be quite enough to justify it, but for more expensive procedures when vacation is available, a good option is to visit one of the excellent hospitals in, e.g., India.
The savings on medical care will easy cover the cost of airfare and hotels. Instead of a painfully expensive hospital visit, you get a nice vacation that includes a detour to hospital. Definitely pick a good hospital if you do this; it will still be much less expensive than in America.
Just a couple of additional thoughts - your son may find that having a fizzy drink on hand while eating is a good idea. If the esophagus blocks, a drink of fizzy fluid can break up the bolus of food and open things up. I always have fizzy diet lemonade with a meal, for that reason.
Also, I have had a esophageal endoscopy with no anesthesia or sedation (just a local to prevent the gag reflex). It does take the ability to relax and stay calm while unnatural things happen, though. However, I don’t know if they could do a balloon dilation under those conditions, because the Schatzki ring can sometimes really hurt under load (it enervates the cardiac nerve, so feels something similar to a heart attack, apparently).
Why wouldn’t it be in the thousands? I get the feeling you’ve never priced out health procedures before.
This is VERY important: when shopping around for this HE NEEDS TO TELL THEM HE IS UNINSURED. In most (though sadly not all) places this will allow him to negotiate. I can’t emphasize enough how important that is. Back when I had no insurance I was frequently able to get a 40-50% discount. You can’t always do that, but the savings are enormous and worth the effort.
You will also find out two more things:
There is no set retail price for anything in medicine. Every place you go will name a different price, and often the people doing the procedure will have no clue how much it costs. It will take time and effort to dig out any number. You’ll encounter a lot of hemming and hawing about “well, if X then Y, but if B in addition you’ll have Q”. Good luck, and lots of patience.
Add-ons. Lots and lots of add-ons. You’ll get a separate bill for everything. So if you find out how much the procedure costs that won’t include the price of the doctor’s fees, or two or three other things that you’ll get along with it, that likely you won’t be told about, and which you will not be able to negotiate.
As an example, back in my no insurance days I required a specific test. After a weeks of footwork where I found the test cost, the doctor fee, etc. and negotiated a 40% discount I paid cash at the time and though I was done. Then two months later I get another bill from a doctor who “consulted and interpreted” on the test, a doctor I never saw and never knew about. When I protested I was told this was “common practice”. I asked how I, a layperson, was supposed to know that. Anyhow, this is the sort of thing you’ll encounter.
Yes. Don’t get cheap by avoiding that. And in all likelihood the anesthetist will bill separately.
If your son is only 20 and you have active insurance call your insurance company and ask if he can be added to your plan. Due to legal changes most places now offer insurance coverage to dependents up to 26 years of age even if that dependent doesn’t live at home, is married, or otherwise not dependent on you for anything. I can’t promise that your carrier will do this, of course, but every insurance carrier I work with absolutely allows adult dependents at this time.
Please note: I am an insurance agent but I am not your insurance agent. I don’t know where you live or what insurance you have and my advice may not apply in your situation. Advice taken internally may require you to contact poison control.
My sister had hip surgery about a year ago. After they (her and my dad) thought everything was paid for (between them and the insurance) they got one more bill for a nurse. The bill was for $900 and the insurance company rejected it. My dad called the office and was told, like you, it’s “common practice” for the extra nurse to be on hand (but she didn’t do anything). Also, they mentioned that the insurance company almost never covers this extra nurse in this procedure.
So while on the phone, my dad questions why they never mentioned this extra nurse before hand, why they needed her, why she did do anything, why she isn’t covered, why she costs $900 etc… They’re answer was “You’re daughter signed the release form to have her in the operating room”. When he asked her about it, she said “Oh yeah, they did have me sign something, I was already half asleep at that point”
He didn’t fight it based on the assumption that if it wasn’t that, the doctor probably would have snuck the $900 in somewhere else anyways.
I know this doesn’t really have that much to do with the OP, I just wanted to give another anecdote that it’s nearly impossible to get a real quote for a medical procedure. You get so many bills from so many different places.
For something like what the OP was talking about, you’ll get a bill from the Hospital, the doctor, the anesthesiologist, possible a pathology bill if there’s bloodwork involved, a bill from the lab if they remove/find anything, depending on the doctor there might even be another bill from the medical group he’s associated with. Unfortunately no one person will be able to tell you how much all this will be and it’s damn near impossible to track down the person that might even be able to tell you all the people that you’ll get the bills from. And even if you can figure that out, so much of it won’t be known until during/after the procedure. For example, if the doc goes in and everything is clean, there’s no lab work, but if he finds something and takes a biopsy while he’s there, that would mean labwork. If the lab is in house, they might keep you under while they wait for the results to decide if they’re going to remove the rest of it and that’s more time with the anesthesiologist/nurses/doctors etc…
WAG $3000-$5000ish
ETA, that’s my guess for what they would bill an insurance company, I’m not sure what kind of discount they would give someone without insurance.
EETA, how long can he put up with this for? Long enough to get out of school and/or get a job with insurance?
I was going to suggest this. Why can’t he be insured on your policy? He’s under age 24 and an unmarried student, right? He was married, but he isn’t anymore. Makes sense to me that he goes back on your policy.
As I mentioned I was there with him. The procedure took 30 minutes and he was back with me. He sat on a bed recovering from the anesthesia for another 30 minutes. I suppose it could be “thousands”, but it seemed like a fairly quick and standard procedure.
I thank you for the general info, with the exception of the ‘get cheap’ comment. If it is really in the thousands there is not enough money between his mother’s household and mine to cover this thing out of pocket at this point. I am trying my best to solve a problem with the limited funds at hand. If the option exists to do this without putting him under and make it affordable (insofar as anesthesia sounds like it is a large part of the cost of this procedure) then I need that info. I am sure he would readily agree to the momentary discomfort in exchange for getting this throat opened back up. In any event it does not sound like no anesthesia is an option for this procedure.
It’s not really about the time, it’s about the room, the equipment, the malpractice insurance, the student loans, the administrative costs, the profit etc. Also, you’re paying more for all the people that skip out on their bill.
A few weeks back I had a brain CT done with contrast. I was on the CT bed for maybe 5 minutes and they billed the insurance $1200 (I paid about $650). My insurance was billed $100 for 1ml iodine (contrast). But you have to remember, I was paying for the two techs, a doctor, the rent on the building, the maintenance on the machine, the cost of the CT scanner (several million dollars I assume) etc.
I had this problem for years, and had Schatzki Ring dilation about a year ago. It has helped a lot, but I do not think it has entirely cued the problem, and it is my understanding that things might get worse again, and another dilation be needed.
Anyway, what I came to say (and the occasion for my :eek:) is that in my experience, having a fizzy drink with food is absolutely the worst thing someone with this problem could do, and makes the blockage both more likely to occur and more painful or uncomfortable if it does.
My advice (if you can’t get the procedure) is take your food with plenty of non-carbonated liquid, and make sure you chew thoroughly. The blockage happens when your food had not been sufficiently reduced to soft mush by chewing.