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The scariest part of moving from Australia to the US was finding out a few weeks before departure that I needed surgery. Most probably surgery in the US.
Long story short (and you can read the long story here), I used to run half marathons. And then I couldn’t because of a bung hip, as we say in the old country.
I’ve required hip surgery since about May 2015, but moving to the US threw a decidedly large spanner in those works, and instead I sat on the sidelines hemming and hawing.
Did I really want to weigh into the fray that is the US Health System? We’ve all heard the nightmarish stories of hospital bills in the hundreds of thousands of dollars. And insurance companies not quite footing as much of the bill as first imagined.
Eventually the pain won and after a few months of appointments and lots of time on the phone with my insurer, I was in surgery a few days before Thanksgiving.
Since I’m still in recovery-mode this post will be some of my initial thoughts and tips, and I’m sure as the bills roll in and I have more time to think, there will be other posts subject of surgery in the US.
MAKE YOUR INSURER YOUR NEW BEST FRIEND
You don’t have to send them thoughtful gifts or a note on their birthday, but do yourself a favour and call them. A lot.
The most important question you can ask is whether a doctor or a service is “in-network”. In-network means that the doctor or service is covered by the insurer, usually at a higher rate. In some cases you won’t have any co-pay at all, and in others there will be an 80/20 split (insurance/you). Keep in mind you’ll have to meet your deductible for the year before the insurers begin to chip in.
“Out-of-network” can mean different things to different insurers and on different plans. You might be responsible for the entire cost of the doctor’s visit or procedure, or the insurer may pay a percentage (usually between 40 and 60) of the cost once you’ve met the separate Out-of-network deductible.
That’s because it is. Don’t feel silly about calling them to check something for the umpteenth time. It’s their job, and frankly, the system is so confusing that the more you check the better.
BE AWARE OF HIDDEN COSTS
This can be a little tricky, because I found that unless I pushed hard, it was difficult to find out exactly what my hip surgery would cost and what would be covered by insurance.
Speak to your surgeon’s billing department and if that doesn’t help, contact her/his surgical coordinator and ask for a detailed breakdown of the costs of surgery. Try to ask detailed questions, if possible.
Examples of questions to ask before surgery in the US:
- Does the quoted cost include anesthesiology?
- Will I need any extra rehabilitation after surgery?
- Are there any other tests/scans involved?
- Will I require any aides (crutches, boots, heat or ice machines etc)?
- Where can I purchase/rent these aides and are there alternatives?
- Can you send my insurer a quote please?
That last question is important. It will allow your insurer to work out exactly what and how much they will cover. You should also receive a letter from them before surgery, confirming that they recognise the procedure is “medically necessary” and explaining how much you will have to pay out of your own pocket.
Don’t worry if you’re a little phone-phobic. Lots of medical institutions have their own apps that allow you to contact your doctor or their staff over email.
LEAVE FROM WORK
Sit down with your surgeon and work out the average time you’ll need off work, then go from there. If your employer gives adequate sick leave, give yourself a few days’ leeway before going back to work.
Not only will you be more relaxed going into surgery, but if your recovery doesn’t go exactly to plan, you won’t need to panic.
If it’s not too personal, and you’re comfortable with your boss, let them know that you’re going to hospital and ask if you’re able to work from home for a few days before going back to the office.
Sitting at home feeling awful is no fun, but it’s decidedly worse if you feel like you have to be at work at the time.
SURGERY IN THE US
If you haven’t been here long, you won’t have a detailed medical history with you. Unless you’ve somehow twisted your Australian doctors’ arm into providing you with it.
Before you see your US surgeon for the first time, take some time to sit and go back through your medical history as you remember it.
Recruit parents and siblings to help you fill in any gaps or confirm bits and pieces that you aren’t quite sure about.
Things to list:
- Any surgeries you’ve had in the past (major or minor)
- Reactions to anesthetic
- Medication or latex allergies
- Any decline in health since moving to the US
If you have scans from home, always bring them with you. An MRI from Australia, saved me from having to get another (more expensive) one here.
So that’s my cursory guide to surgery in the US, written with a hip brace strapped to my side and crutches leant against the kitchen wall.
What do you think? What have your experiences been? Do you have any tips for first timers?