Saturday, July 31, 2010

The Financial Burden of being a nose revision patient

What are all the financial costs of finding a good nose revision surgeon and cost of nose revision surgery?

Answer: A fortune

1. Travel:
Travel costs of course vary for each individual. When finding a surgeon out of Country or State/Province your first cost is the cost to travel for a consultation. So you have flight, hotel, food, and Surgeons consult fee to incur here. Lets say you stay couple of nights within the city your surgeon works in, this with other costs then could cost about $600 for hotel, cab $75 back and forth, esp from airport to hotel, $125 food for 3 days, and consult fee of $200. Total = $ 1000.00 plus cost of flight, lets say $600 for a Total = $1600.00

That's if you see one nose doctor, if you see more then one in the same city then you just have to add consult fee of the other surgeon and maybe additional cab fair.

Now say your not happy with that surgeon and you need or want to see more nose surgeons which require you to travel to another city.  Well if your able to do that within the same trip lets say as your above trip, then cost of flight might be extra $250.00 and hotel for couple nights $475 with food, cab $60 and consult $200 for sub total of $985.  Cost of whole trip:  Total =$1600 + $985 = $2585.00

Now you decide to go with one of the surgeons you have seen, so now your costs will include the surgery cost, and hotel costs for 7 to 10 nights of stay, since you are not suppose to fly after nose surgery that amount of days.  So cost of secondary revision surgery lets say conservative figure today $12,000.  Now add hotel fee for lets say 8 nights at $200. for amount of $!600 plus food, $320 and flight $650.00. Total = $14,570
If your taking a companion with add cost of additional seat on flight, food, etc.

So total cost = $2585 + $14570 =$17,155.00

Remember you will need prescription medication which is however a nominal extra cost.

Now that's with one revision nose surgery. What if your outcome isn't successful and you require more surgery? Well again, you have to travel for the consult appointment, and then travel again for the surgery. Very rare will someone book surgery with the surgeon before the consult or be able to arrange it right after the consult all within one trip. So first off to heal properly it takes about good 2 years before having another surgery. Mentally it may take as long as 5 years until your ready to do this again. Well in 3-5 years time prices the surgeons charges goes up, and now that your coming to see surgeon with more history and problems the cost because of that goes up substantially. Lets leave the costs from above the same except for the surgery cost. Now your nose revision cost is $ 15,000 lets be again conservative. So adding that to all your other costs and you end up with $3000 more then above total, which then will be a total of $ 20,155.00

So cost of two revisions cost you total of $37,310.  Having two revisions would not be unusual.

Unfortunately, its at this point where one realizes if it has failed again, that seeking out the best revision nose surgeon is crucial. So your still having problems with your breathing the results of the cosmetic nose revision is showing poor results after couple years now what? A tertiary surgery, Oh damn! Why wasn't I more selective about who i chose from the very beginning. Well don't kick yourself even the best of the best have bad days.
But you need a 3rd revision and its not because your picky its because you didn't have the right surgeon perform the right procedure.  OK, here we go again, now the top revision specialists quotes you $20,000 to $30,000 with anesthesia costs. Lets agree on $25,000 to correct the mess, and add the extra costs using same figures as we used above, so the cost this time around totals=$30,155.00

Now assuming you didn't travel to other city's for consults which you decided not to go with that particular surgeon, your total costs for the 3 revisions now totals= $67,465 dollars.  Hopefully 3rd time was a charm. Oh but wait the surgeon requires for you to do a follow up with him/her. Some ask for more then 3 follow ups. Lets say you do one follow up in a year, so cost is lets say as above example $1400. no charge for follow up appointment. So new grand total of $ 68,865. Wow nearly $70,000. And most likely its not at all covered, so it's all coming out of your pocket. With a companion it would be at least that much. And the prices these surgeons are charging isn't slowing down anytime soon. It pay's to be rich, or becoming a revision nose surgeon.

Friday, July 30, 2010

The unscrupulous fee practices by revision rhinoplasty surgeons

  What's unique but questionable in regards to nose revision surgery especially revision nose surgery for functional breathing related issue's, is that it is the only surgery that i know of where you have to pay out of pocket (in full in some cases) in order to improve your health condition even if you are a citizen of a country which offers Universal health care, like that in Canada.  For the few that are lucky enough to qualify in getting  insurance coverage in Canada, or the U.S.A,  they will still be out of pocket for the "cosmetic" component of the surgery which will likely end up being 50% or higher of the total surgical fee. The nasty trick here which the surgeon engages in is that the cartilage/bone grafting replacement surgical time to correct nasal valve collapse (the functional issue) gets billed as 'cosmetic' surgery since it simultaneously changes the aesthetics of the nose.  It's nearly impossible to not change the aesthetics of the nose when you add supporting material to it.  The surgeons office team understands all this.  When you get a price quote after your consultation it's for the amount not covered by insurance/government. If your complaint is strictly functional as in the case of nasal valve collapse the surgeon's office will likely tell you the surgeon doesn't take on cases unless they also have a 'cosmetic' component forcing you to agree to those terms since there's no other way for you in getting the functional surgery which you desperately need; hence the unscrupulous financial shell game trap! In Canada, it's improbable that any portion of nasal valve collapse surgical costs would be covered by the health care system. Same problem for getting coverage for empty nose syndrome corrective surgery.  In addition to this most e.n.t. surgeons aren't aware or refuse to  recognize empty nose syndrome as a real serious condition and many don't know how to treat, let alone diagnose nasal valve collapse.

 Now as for Provincial or Federal Government financial assistance coverage don't expect a Plastic Surgeon to even help you apply. I had asked one Plastic Surgeon who is considered the best rhinoplasty surgeons in my city to see if I could get  provincial health coverage to help cover nominal amount towards the surgery I need, (since he and no one else in the province could correct the problem with my nose). He ended up giving me the run around. First he told me it wasn't going to be much money and then recommended that I should ask an e.n.t doctor. I think he was afraid his reputation would look bad, to admit to the government that he couldn't do the surgery which meant I would need to seek out a more qualified specialist. He agreed with me I should pursue finding a surgeon out of the country who specializes in revision nose surgery yet was still unwilling to be of any help. He couldn't even recommend a U.S. surgeon. In Canada, If you need to have surgery outside of  the country  you will not be eligible for any reimbursement, without a surgeon's referral stating that the level of care or procedure you need is not available in Canada. In my case, I already had 2 major revisions, which made my problems worse and one of the surgeons was considered a top nose revision surgeon in all of Canada. So  I need a highly skilled nose revision surgeon, like those in the United States, to correct my breathing issue's. This is a terribly unfair situation considering revision nose surgery for nasal valve collapse can cost upwards of $25,000 U.S. by a reputable experienced surgeon. The cost for empty nose syndrome surgery exceeds $10,000.  There's also the cost's of travel, hotel stay (you can't travel for 7-10 days after nose surgery) supervision by nurse for a day (if unaccompanied for the surgery), medication and food. If that isn't bad enough, some surgeons don't even offer financial payment plans. In these situations the person who needs the surgery may not be able to afford it.
     If you had unsuccessful eye surgery or ear surgery, and needed revision surgery because it made your sight or hearing worse, you most likely would be covered fully by the health care system in Canada , even if it was necessary to leave the country to get it done by a more qualified specialist. Unfortunately nose surgery is in a infamous league of its own when it comes to repairing the serious outcome of nasal valve collapse or empty nose syndrome that affects your breathing.  Nose revision surgeons in the case of nasal valve collapse will not go ahead with the surgery unless the patient pay's a fee which falls under the  "Cosmetic" category even though the major or full complaint is a "Functional" breathing issue.  If you are insured then the nose surgeon additionally bills you for the cosmetic portion which is above and beyond what the insurance company covers for the functional portion. Depending how exorbitant the overall charges are some have ventured to say it's like a double billing system. If you have no insurance whatsoever  then you will end up paying the full amount out of your own pocket including the mislabeled 'cosmetic' portion even though you are suffering primarily or exclusively with a functional nasal disorder.  If you don't agree, to pay for the 'cosmetic' portion or have what is considered a cosmetic procedure in addition to the functional procedure then you are left out in the cold.

Many ent's  who aren't familiar with nasal valve collapse don't understand why you need to go out of the country for the surgery. Many don't realize the complexity of the surgery, with regards to proper nose grafting procedures and the expertise and experience that a surgeon needs to perform such complex revision nose surgery's with consistent successful results.

Nose revision surgeons in Canada, should also become active in recommending that the health care system cover a larger amount then the minuscule amount being offered now towards the revision surgical costs. An amount that is at least PROPORTIONAL to the SURGICAL TIME needed to correct the FUNCTION of the nose. We pay into the system through our taxes. We should expect equal and fair compensation like other surgery's would receive, especially when considering the fact that a nose surgeon within our own country was responsible for these breathing problems in the first place.   

There are also no set rules in how facial plastic surgeons (in general) divide up the fee's between the cosmetic and functional components. The nose revision surgeon arbitrarily decides what that breakdown will be. The portion the Government or Insurance company's covers (if you had prior nose surgery it may be very difficult to get any Insurance coverage) is the functional portion claimed and the usually much larger balance not covered is the cosmetic component.  If you don't have insurance or not able to qualify for it, and have the surgery in Canada as a citizen, the  provincial health care portion claimed by the surgeon is considered the functional component which is negligible.   

So how small an amount is this provincial government portion that is claimed for the functional surgery of the operation? Well very very small. There are different codes that are used by the surgeons when they make these claims, so it can be confusing to exactly what amount goes to the operation and what amount goes towards each consultation. With that in mind from my surgery in 2001 performed by a Plastic Surgeon the amount claimed for the operation was  $508.40. From my surgery performed in 2005 by an E.N.T/Facial Plastic surgeon the amount claimed was $307.75.  How much was I charged for the two surgery's? The Plastic Surgeon in 2001 charged me around $5500 for a 3-4 hour revision surgery. The E.N.T./FPS in 2005 charged me $7700 for a one and half hour revision surgery. So in other words the Functional component claimed in 2001 worked out to less then 10% of the total charges, and the Functional component claimed in 2005 worked out to less then 5% of the total charges. Note: My two only major complaints with each of those surgery's was 1) My problem with breathing due to collapsing of the nasal valve (a result of primary surgery) and 2) The projection and angle of my nose tip (also a result of primary surgery).

If the nose revision surgeons really care at all about these victims they would be addressing these issues with the health care system. Isn't being able to breath through your nose an important function??? The real irony is that nasal valve collapse is a condition that is primarily caused by poor primary nose surgery (iatrogenic). Empty nose syndrome which is more rare, is a result from over aggressive removal of the inferior turbinates and/or middle turbinates (also iatrogenic).

Many nose patients are unaware of these serious potential side effect before the surgery, and when it occurs, more often then not, the nose surgeon can't or will not correct the problem. The patient is now, not only out of pocket from the first surgery but has to pay out of pocket for the revision. Worse, like in my case, when you don't have a successful  secondary surgery  you are further out of pocket and the more nose surgery's you have, the higher the price a Nose Revision Specialist will charge you for another corrective procedure.

There's no question  greed and/or apathy has set in with some of the nose revision surgeons. They need to prove they care not just about  getting paid but also about their patients financial situation.  The health coverage   should cover the full true functional costs of nasal grafting revision surgery. These specialists should become philanthropic by becoming more vocal and active with helping their patients get appropriate  amount of personal insurance or provincial health coverage, not charge exorbitant fee's or play this financial shell game and offer a reasonable monthly payment plan. Its really in their best interest as well as the interest for their potential patients. 
It's a serious problem, that won't make front page news and therefore not likely much if anything will be done to address these unjust situations. The nose sufferer not only is a victim of his/her previous mishap surgery but also victim of this financial shell game practiced by revision rhinoplasty surgeons which discriminates against the poor and has been let down by our universal health care system. Some may end up having to take out a loan or second mortgage on their home or find someone that will borrow them the money. Some may even have to sell a valuable possession of theirs (i.e. Jewelry) to come up with the money.  For the  nose victims who just can't come up with the money for the surgery, they will have to become more proactive with trying to get government officials understand these pressing & unfair issues, & in mean time find alternatives to rely on such as; nose sprays, decongestant pills nose splints or possibly a  cheaper priced minor surgical procedure that may give some relief temporarily,  until they can afford the appropriate surgery. And  in the mean time the surgeons fee's, as well as hospital and clinic fee's will all continue to escalate.

Closed vs Open nose surgery

Most Primary (first nose operations) Surgery's are done by closed procedure, so no visible scars can be detected. However with revisions that require more extensive work that correct problems with collapsing of nasal wall, these Secondary or Revision Surgery's are done by Open procedure. There are few surgeons who will prefer closed technique, but they are the exception. There are advantages and disadvantages to both these procedures. If you have too many open procedures you risk greater chance of developing necrosis. With closed the drawback is you don't see the whole area that your working on, and you can't as easily place as large a graft as you can with open procedure. With closed you disturb less of the tissues of the nose, and you can have a better and faster idea how the nose will take shape. Its less invasive and heal time is much faster.