Thursday, January 17, 2013

Novasure, anyone??

Disclaimer:  I am about to get long winded and very personal.  So if you are just a drop in of happy, healthy family reports, of good food, vacations, and happy life, check back in later.

Next week, I will be going under the knife.  I should say radio frequency energy.  Basically, I am getting Microwaved!

I have been searching for information about the procedure for a bit, and other than the complainers (which is completely allowed for negative experiences, very little is said for the before and after.  It has been either, it worked great, or I am no better off.  A couple of horror stories, thrown in for good measure too.  No one that I have come across has yet to tell me what to expect.

So as I venture down this path, I am going to start chit chatting about it.  Test leading up to it, and eventual cost of the thing.  I will not be polite about the cost.  Actual figures of what will and wont be covered, is mentioned.  Please do not be offended that I am talking about money (a bad American trait, I have been told) because I know I am not the only one out there, looking for the financial repercussions of doing what is seen a simple, basic surgery vs living with it.

If you are one of those people who freak out when someone mentions stirrups, don't continue to read.  I may be too obscenely graphic for your stomach.  I probably wont be, but you will get TMI about my personal health history.

 If you want to know cost, just scan to the bottom section.  I will add the surgery cost when I get my hands on the Bill.

General Background of problem:
June 2008 Minor office procedure to install Essure.  Only real side effect for me has been the shorter and shorter cycles.  This can be a side effect, as it sometimes regulates uneven or far in between periods.  Not loving the monthly hits of hormones, but no more babies please!

I can't blame the Essure for what I thought was a side effect. Fast forward through the following details and the result is I am a polyp field ready for harvest.  For all I know, the change in my hormones from having the Monster, settled at a point that encouraged these growths. Or I just inherited the peri-menopausal genetic coding that runs in the family. (Hello early menopause, in your 30's!!)

So from about mid 2009 to October 2012 I lived with the craziness.  Partly because I didn't think there was anything I could do about it, and mainly because I was terrified of the cost.  With no medical, and being denied medicare for myself during Papa's unemployment, I just dealt with the cards I had been given.

As a side note, I have always been crazy irregular in the girly department.  I am talking for every 3rd 45-52 day cycle with moderate 4-5 days of ick, was followed by a crazy heavy 3 day flush at the 28-32 day mark, that left me huddled in bed.  I also was on clomid to get our first child, and tried to use it for the 2nd, he came on his own accord, a couple of months after we finished a failed 6 months of hormone hell.  So, naturally my body does what it wants.  I usually just go with the flow.

End of October 2012, I went in for a yearly visit.  The first in 4 years.  I mentioned my crazy cycle changes from above to the current short 21 days from day 1 to day  1 of bleeding, and 9-13 days of crazy light to heavy mixed days.  I also have had at least 2 days were I really couldn't leave the house due to clots dropping, and maxing out my protection in 15 minutes.

If you just did the math, you would have realized I was looking at about a week to 10 days of not bleeding.  Add in some crazy crazy PMS and you all think I am nuts for not going in sooner.

So why didn't I call a doctor, or go to the ER?  I would give myself a set time to stop and I always would. Or one month would be horrid, followed by a vastly improved month where I had a whole 20 days of not bleeding!! I also didn't want to go through endless test, and be told to loose weight.


It is the be all, end all, diagnosis to all things medical.  Loose weight and your problems, xy and z will probably disappear.  I get it, for some people it is a big deal (hello fast food lovers) others not so much.

I am not fat.  I am overweight.  Genetics play a role in that, as our women folk like to store fat for famine.  Our fat provides a place for the crazy gene to sleep, otherwise, Hello Lunibin.  Not to say all the skinnies are nuts in our house, but if I get upset, I eat chocolate, I feel better, I move on.  I would rather eat chocolate and be happy then deny myself and sulk in a mood.

Needless to say it was mentioned at this doctor visit, BUT my doc did suggest a plan of action.

Besides draining me of all the blood they legally could (I jest, but at least 4 vials, and 12 blood test) , I got scheduled for a Hysterosonograpy with a biopsy.  The latter would be set but may be cancelled if my blood work came back with a hormonal imbalance, diabetic or pre-diabetic result, or any other overall markers that would make them want to do a different test first or result in medication therapy.

Guess who got to come back and get in stirrups?

When I met him a month later (nov 2012) he was absolutely floored at my test results.  I am extremely healthy.  I may be storing for a famine to hit my body, and have had repair work on my heart, but everything came back within normal limits, not borderline, dead on, smack in the middle, normal.  My blood pressure was even ideal.  I laughed and told him, in my family, the skinnier you are, the more unhealthy you are.  I don't think he believes me (although he should).

So fast forward 15 minutes, a painful biopsy and many failed attempts at the saline catherization to check my uterus, we see it.  A lovely little mass, at about 1-2 cm in size, resting peacefully along the back wall.  I guess I have a polyp.  Better than a fibroid, but still.

That little booger.

It is small, lonely being that it is by itself.  You wouldn't even think it was big enough to bother with, until you start researching these things.

If you have one, that can be clearly seen on the ultrasound it usually measures between .5 and 1cm, and rarely do they get to be close to 2cm, heaven forbid 3cm.  So on all accounts, it is small, but big enough to have friends.  Friends that aren't often seen on an ultrasound.  Ones that hurt you and scream as they are biopsied out.

They sent it out for 2 opinions.  Darn those inconclusive test but the biopsy end result said, no cancer!  That is the silver lining.  (precancerous polyps have been found in family members)

So now I sit, one week away from having the Novasure procedure done.  Some people rave about it being the best thing ever.  Others have had issues.  A lady I work with is dealing with her issues from it.  But for me, this is the right step.  Keep my hormones as long as possible (better for my heart) in and out procedure (better for my wallet) and quicker healing time (better for anyone who may have to work with me, or be near me).

Overall, I can't wait to get it over with, but I am fearful of the cost this thing will set me back.

According to our insurance estimate of cost calculator, in our Area, having this done at a hospital is around $16,000.  Give or take a grand or two.

Participating in a Medical Plan, drops it down to about $10,000.

Our high deductable, co-insurance amounts, and misc not covered by our medical....$9000.
Leaving our Medical insurance company paying out about A Thousand Dollars.

That is just for the surgery.

Any additional pre-op testing is on us.

I am dreading this Bill.

But for those of you out there, searching for information on how much this will be costing you, (I was one of them)  here is a breakdown.

To Date:
The Preventive/yearly exam  $223.00 - ($164 office visit, $55 pap, $6 urine chem)
Lab work, Blood Panel screening $352 - ($71 anatomical, $280 Clinical) 
Total Cost of Yearly/Preventive Exam and Labs = $575
Covered by our Medical $473, out of pocket $112

Hysterosonography w/ or w/out color flo $190.
Catherization & introduction of Saline $610.
Expanded focus (not sure what this was) $95.
Total in-office Biopsy and Sonogram $895.
covered by our Medical Insurance $95,
Written off (medical insurance in-network pricing deductions) $441.
out of pocket $ 358.

Pathology from Biopsy during Hysterosonography Lab 1 $112. 
Medical Insurance $47, out of pocket $65. 
Pathology from Biopsy sent out for inconclusive results    $160. 
Medical Insurance $105, out of pocket $55

Total Billed to Insurance - $1742 
Total Covered or "written off" - $1159
out of pocket cost $583.00

Of course, all of this is on LAST years deductible plan, so we are restarting from scratch for the surgery. But overall, 66.5% total cost was covered or written off because we have medical insurance.

Next week, fortunately, we can have procedure done at a surgical center.  This will help cost wise verses a hospital.

We are being billed at an in-network 80/20 rate for use of the this center.  It will go toward our out-of-network billing though, because technically the place is not in network.  My doctor and the anesthesiologist, are in-network and part of the physician owners for the place, and are trying to help keep patient cost down.

We already know, to use this place it will cost us $590.00, due the day of surgery.
Because the office we are going to in not in-network, our Insurance can not estimate a cost for this procedure, but instead can only do it based on the local hospital rates.

At a local hospital it is estimated that of the $16,000, $8,000 is the hospital charge. resulting in about $4500 after discounts through our medical insurance provider.

The expected $9000 could easily be accounting for about half going to the Hospital Bill alone.  If we are correct, in theory, by going to the center our bill has just been sliced in half.  This makes sense if you take the 590(20% rate), and figure out that the full cost would have been $2950.  Using this offsite location is saving us.  I will let you know if this is correct later.

The doctors bill will come later.  In-network, so a lower price point, but we anticipate having to cover $3600 of it.  That is our deductible.

After that we have a 80/20 plan up to $7000.  That is another $1080, if the initial estimate is correct by our providers website. (remember that $590?  It doesn't get applied to this either, it goes in a an different pot of $12,000 responsibility)

I have seen cost examples ranging from $1500-3000 for doctors fees, and $500-1500 for drugs and the administrator of them.  If we luck out and these are correct we will save just a fraction, should all my misc math and assuming be true.  But we know what assuming can do...

You can bet, that after this is done, I am spending the year visiting doctors.  I will be pushing to see my cardiologist, getting hubs in for anything that has bothered him, making sure the kids are at 100%,  I might as well take advantage of the 80/20 plan, while I can.  Otherwise, I will be too busy to do anything this year.  Have to pick up some extra shifts at work to pay this bill off!

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