Beating Heart Disease: Shopping For a Surgeon

(This is the sixth in a series of blogs on heart disease. The prior installments are in the Patch archives.)

Throughout this ordeal I ‘ve been blessed with an incredible insurance plan thanks to Patch, a division of AOL. But even great plans like mine have limits. One is the fact that insurers negotiate what prices the will pay to providers – the hospitals, doctors, therapists, and etcetera who comprise their “network.”

Network providers give insurers deep discounts off standard rates. I learned just how deep these discounts could be when I got a copy of the bill for the angiogram.

The hospital billed $24,499 for the procedure. From that it subtracted an insurance company discount of $22,632.

That left an actual charge of $1,867. I paid just 10 percent of that, or $187.

A different and higher set of charges would have pertained if I had gone out of the insurer’s network – or had no insurance at all. This last fact sets up the situation in which uninsured patients, those least able to pay, get the highest charges.

In any event, I wanted to be sure that my surgeon was a member of the insurer’s network. So I went doctor shopping on the website where the insurer lists pre-approved surgeons.

But not much information is provided. Here you are, about to put you life in someone’s hands, and basic data is difficult to come by. I was told to look for a surgeon who did a lot of bypass operations. More experience is supposed to lead to better outcomes. But if such information existed I never found it.

Finally, after getting more recommendations from my cardiologist and doing some research on my own, I found a surgeon at UCSF who was covered by my plan. So was UCSF itself, which is located in San Francisco and is one of the world’s great research and teaching hospital.

Two weeks passed between the angiogram and my first appointment with the surgeon. That’s not a lot of time in the greater scheme of things but it seemed like forever now that I knew that I was walking around at risk of a fatal heart attack.

On July 19, I visit UCSF to meet my surgical team and learn about the coronary artery bypass operation.

(Follow the series in the Patch archives.)