Custom Surgery Packages For People With No Insurance

September 15, 2016

What if you were uninsured and needed surgery and choice? What if you wanted a surgeon you could trust and convenient service at a price you could afford? Would it help you to have your service custom built to fit your needs?

We ask because that's what happened to one of our customers. And because she chose a surgery service designed and built from scratch, which helped her overcome barriers to care.

Here's the background. Surgeo designs and delivers comprehensive surgery packages led by highly qualified peer credentialed surgeons. You can see some of them listed on the web site. Many of our packages are built and delivered before any specific customer comes along. We call them our durable packages.

One day, we were approached by a Linda (not her real name), a woman in Illinois, who had a kidney stone. She was in pain and needed that stone removed. Linda's problem was partly that she had no insurance and did not have easy access to an insurance company network. This made it harder for her to get appointments with urologists -- she didn't even know who they might be -- and it meant she'd have to shop as a self-pay healthcare consumer. She'd be responsible for finding the right surgeon and negotiating the terms of her service.

Linda did what many people do in this kind of situation: she went to a local hospital for direction and service. Here's the problem with that approach: many hospitals are staffed by non-medical personnel who cannot manage the clinical aspects. Moreover, they are often not sure which service to organize and price. In many cases, one finds the "blind" leading the "blind," which for a patient in real physical pain is exactly the wrong situation. Linda, who had had urinary stones before, thought she needed a removal or laser treatment of a stone in her ureter, and so she asked for this procedure. She was quoted $16,000, to include surgeon and facility.

Not satisfied, Linda turned to Surgeo for help. Surgeo did what it always does: had her history reviewed by one of its appropriate surgical specialists. In this case, for her convenience, we worked with one of our surgeons in nearby Milwaukee. That's the beauty of a surgeon peer-to-peer network: it can get you to the right surgeons in lots of places and for lots of needs.

The clinical review, which cost Linda nothing and included review of her CT scan, found that she had a kidney stone, not a ureteral stone as she thought. And this stone was really large, which meant that she might need a procedure through her back, not her ureter (percutaneous lithotripsy, not ureteroscopic lithotripsy). That procedure through her back would have required a hospital stay and more expense.

With the Surgeo surgeon, Linda decided that she wanted the procedure through her ureter. This offered a good chance of solving her problem and it cost less. Here was the problem: the surgeon normally did these procedures at a large -- expensive -- hospital. And the ambulatory facility at which he was on staff did not have the laser equipment needed. Plus Linda had no agreements in place with any of them for price, ancillary procedures, or what would happen in the event of complications.

To address Linda's need for comprehensive service and clear terms, Surgeo put the surgeon, anesthesiologist, facility, including a laser company, under contract. That contract obligates them to a flat fee, which includes ancillary procedures, if any are needed, and to leave her alone after services are rendered. In other words, after surgery, Surgeo's downstream providers have to take up any questions or issues with Surgeo, not Linda. This gives her financial and administrative peace of mind.

There's one more thing: complications, which can happen during and for varying periods after any surgery. In the case of a kidney stone surgery, complications can be such things as sepsis and heart attack. Surgeo protects every one of its customers against complications first by working only with surgeons who have passed its peer credentialing process. It protects them also by building its packages to include ancillary procedures. For example, if you're having a gastric sleeve weight loss surgery, the package includes an ancillary hiatus hernia repair, if needed. But none of that protects against complications, like sepsis or heart attack.

To protect Linda in the event that, despite all precautions, she did have a complication, we built in a financial feature. Think of it like collision insurance that you get when you rent a car. In this case, she got up to $25,000 in coverage for up to 12 months after her procedure in the event of a complication due to surgery. This is something that nobody else provided.

The flat price: $11,000.

The outcome: no more stone, no complications, no surprises.

The community: Linda belongs to Samaritan Ministries, which takes a Biblical approach to sharing the expenses of health care. It appears that her financial need will be addressed by her fellow members. It appears that a whole community has come around Linda in her moment of need. It feels like we're beginning to work together to simplify access to quality care. It feels right.

Parting thoughts ...

By going through Surgeo's surgeon driven surgery logistics, Linda was able to get new choice. That choice was led by a highly qualified, peer credentialed surgeon who got the job done cleanly. She got a comprehensive surgery package that included all the things she needed plus protection in the event of complications. All at a cost that was substantially lower than her other choice, where she was not even sure who the surgeon would be.

Not every medical situation is right for a customized surgery package. Many are. We've built customized flat-fee, comprehensive surgery packages for patients with cancer, knee injury, erectile dysfunction, and kidney stone. We've seen customized packages break down economic and geographic barriers to critically needed surgery.

If you know someone who needs surgery -- a qualified surgeon, comprehensive service, administrative clarity -- and is having a hard time finding it, let us know and we will see what we can do to help. And if you are a surgeon or facility and want to participate, by all means make contact with us.

Learn more about Surgeo's surgeon driven surgery logistics in this conversation between Chris Porter, M.D., a general surgeon, and Arnon Krongrad, M.D., a urologist and founder of Surgeo.

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