May you live in interesting times.
I’ve had this running through my mind today. And to whichever Chinese smartass came up with it, I say: fuck you. I’ve had more than enough interesting.
There is, however, good news…I’ll get to that in a minute.
This morning, I phoned three hospitals to find out the feasibility and cost of their doing the heart cath. They were Tampa General (in, logically enough, Tampa), the Mater Private in Dublin, and London Bridge (logically—again—in London). Each said they would be happy to do the procedure on a self-pay basis. The cost? It ranged from $3,500 to $5,000.
At Tampa General, their policy for uninsured patients is, depending on income, to charge 115% of the Medicare or managed care price for any given procedure. The Medicare rate for the heart cath is $2,587.
Having made these calls, we went to see Dr. Desai.
I want to be very clear here. Dr. Desai has been a hero. He has done his best to get Brigham and Women’s to honor what they told me the cost and payment options would be for this procedure. That he was unsuccessful was absolutely not for lack of trying. He also spent more than an hour with us today; I suspect he forfeited his lunch to do so.
Dr. Desai was incredibly apologetic, even though he did everything in his power to correct—and had tried to prevent–the situation with the hospital over the last couple of days. He did manage to get me a printed estimate, which is (are you ready? This isn’t a typo!) $43,943.65. That’s 41,356.65 more than the Medicare rate, which, according to the interwebs, is close to the average managed care cost.
Good News Alert! Dr. Desai did a thorough physical exam, listening to my heart and checking my veins. He was pleased with my response to the medications. He said that he was torn about not checking me into the hospital when we were here before, but I’ve clearly responded well to the medical treatment. He doubled my dosage of carvedilol because I have not suffered with side effects from the smaller dosage.
We talked at length about the options with the heart cath. Dr. Desai is happy for me to have it done in any of the three hospitals (since paying the BWH price isn’t going to happen), and will identify and communicate with a cardiologist at whichever we end up using. But because there will be a bit of a time lag until I can have it done, he wants me to have a CT coronary angiography (CTA—and yes, every time I see this, I think of the El).
The CTA could have two outcomes. It could be normal, which would mean that I could delay having the cath until January because it means my arteries are in decent shape. If it is not normal, it will be important that I have the heart cath within a few weeks, because additional surgical procedures might be necessary. The CTA will not provide the data about the strength and pressures in my heart that the cath will.
Dr. Desai gave me the option of having the CTA here in Boston, which sounded like a good idea until the money folks said it would cost $4,242. At an imaging center in Florida, it’s $1,250. So Dr. Desai has arranged for me to have it there. I’ll make the appointment tomorrow; it will probably happen early next week, certainly before Wednesday. They’ll do the scan and give it to me on a CD, which I will overnight to Dr. Desai. He will review it with the radiologists here and let me know the results.
Months ago, we made arrangements to go to London on November 13. Dr. Desai said it will be fine to make the trip, and since we’ll be there anyhow, if I do need the heart cath before January based on the CTA results, I’ll have it there.
So we’re heading home tomorrow. I need a few days of boring to balance all the interesting!
Thank you for reading, and for accompanying me on this journey.