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Out of pocket decisions

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Dapperdan7
Dapperdan7

so because i am still years away from medicare paying for cat surgery (and as i understand it its not automatic at 65. the doctor still makes the call if he determines it to be bad enough), i am trying to be extremely careful with my choice of eventual surgeons. i have an appt w a doctor in 2 weeks and since the visit is expensive, i would like the doctor who i see for my yearly checkup to be my surgeon.

now i originally thought the 4 most important choices were 1. competency as a surgeon, 2. working with the lens i want to use 3. patience to answer lots of questions. 4. ability to see them personally on post surgery follow up appts.

im no longer concerned with 3# as long as one does the research, i dont feel i will need a doctors opinion as they are my eyes and i will know better than anyone what i want

but the difference in cost here in chicago between the ones most recommended and all the rest is often at least double. now of course i want the best, but i wonder if a large part of the price difference is less skill and more reputation: ie the doctors charge more because they know they can get it. im doing as much research on the less costly ones (who all seem to have loads of experience and good credentials) but wondering others thoughts when they were paying themselves and had too many choices. thx

0 likes, 26 replies

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  • Dapperdan7
    Dapperdan7

    Posted

    and the wait to see the expensive ones are ridiculous to boot!

  • phil09
    phil09 Dapperdan7

    Edited

    Certainly reputation and other market factors unrelated to skill/outcomes are a large factor in pricing. As they are in markets for many goods and services.

    Medicare is not the only insurance that pays for medically necessary cataract surgery. Are you not planning to obtain/use insurance for your surgery? If not, why not?

    • RonAKA
      RonAKA phil09

      Posted

      I don't know much about medical insurance in the US, but wouldn't they exempt any "existing conditions" from coverage?

    • phil09
      phil09 RonAKA

      Posted

      No, not anymore. Under the "Obamacare" legislation enacted over a decade ago, pre-existing conditions limitations were largely outlawed in America. We are now a lot more socialist in our health insurance systems, although we still have a ways to go before we turn into Canada.

    • RonAKA
      RonAKA phil09

      Posted

      If that is the case then it may make some $$ sense to buy insurance before surgery.

      .

      Canada's system is a mixed bag. It varies quite a bit from province to province, but generally a basic monofocal is covered, and in some provinces you only pay the differential if you opt for something more. It also varies in what measurement methods are covered or not. Strangely our antibiotic and steroid drops are not covered in most provinces. I guess that is because we don't have government pharmacare yet...

    • phil09
      phil09 Dapperdan7

      Posted

      Might be profitable to get some, even if you drop it after your surgery. Most everyone in the US is eligible, and open enrollment runs from November 1 thru Jan 31.

      Either way, good luck with your costs and your surgery.

    • maura04015
      maura04015 phil09

      Posted

      My understanding is that while a company can't refuse you coverage over a pre-existing condition, they can jack the cost to where it's no longer feasible for most people. That's from my doctor. My own experience is they do investigate your current medical status at the time you apply very thoroughly. Even so, it would be worth checking out and doing the math to see if it would be worthwhile.

      I've never heard that Medicare isn't automatic at 65 for any U.S. citizen who paid into the system, but if I suspected I was somehow an exception, I'd sure check it out.

    • phil09
      phil09 maura04015

      Edited

      Hello Maura - Your doctor's insurance advice is incomplete or woefully outdated. (His medical advice may be excellent.) By law, individual medical insurance under the Affordable Care Act of 2010 (also known as Obamacare) is subject to "guaranteed issue". The insurer cannot legally deny your application, nor increase your premiums, due to a pre-existing condition.

      Medicare Part A (which covers hospitalization) is pretty easy to qualify for, and is automatically available at age 65. Part B covers outpatient care such as cataract surgery, and is also easy to obtain at age 65 for those who have sufficient work history, but it does require affirmative election and a monthly premium payment, so not exactly automatic.

    • maura04015
      maura04015 phil09

      Posted

      "Hello Maura - Your doctor's insurance advice is incomplete or woefully outdated. (His medical advice may be excellent.) By law, individual medical insurance under the Affordable Care Act of 2010 (also known as Obamacare) is subject to "guaranteed issue". The insurer cannot legally deny your application, nor increase your premiums, due to a pre-existing condition."

      .

      Sorry for the confusion. I'm past worrying about Obamacare, thank God. My doctor was talking about Medicare -- I was applying for a supplement policy, and yes, they sure can charge you more if you have existing medical problems. Right on the issuers' websites it will show you what you pay if you qualify for the price and what you pay (roughly double) if you have certain problems.

    • Bookwoman
      Bookwoman maura04015

      Edited

      If you're talking about Medigap policies, by law you cannot be denied coverage IF you apply within 6 months of starting Medicare. If you wait, however, then they can indeed deny you coverage or charge you more for a policy.

    • phil09
      phil09 maura04015

      Posted

      "Sorry for the confusion. I'm past worrying about Obamacare, thank God. My doctor was talking about Medicare ..."

      Ah, that explains things. I was addressing Dapperdan7's situation - it sounds like he is not yet Medicare age. You are right that there can be limitations or added premiums on Medicare Supplement (Medigap) insurance. As Bookwoman notes, those penalties are avoided if you enroll during the six-month guaranteed issue period.

      There's also Medicare Advantage - it has no pre-existing condition exclusions, and no premium penalties so long as you enroll timely. Open enrollment started this week and runs thru December 7.

    • jimluck
      jimluck Bookwoman

      Posted

      You can't generalize about Medigap policies. The groundrules are different in different states. In my state (Massachusetts) we have a guaranteed-issue law for Medigap policies. What you say is probably true in most states, but not here.

      In New York and Connecticut, Medigap plans are guaranteed-issue year-round. Massachusetts has a two-month window each year (February through March) during which Medigap plans are guaranteed-issue

  • RonAKA
    RonAKA Dapperdan7

    Edited

    Here are some more things to consider:

    .

    1. I would not consider having cataract surgery to anyone other than a specialist that does hundreds if not thousands per year. I don't think many ophthalmologists do it as a part time job. If they are doing it full time, there is very low risk that they will be not good at it. Practice makes perfect!
    2. Don't underestimate your ability to have the surgeon do what you want. Many are even resistant to give you your eye measurements and IOL Calculation sheet. That piece of paper is what gives you the ability to have an informed conversation with the surgeon and know what you are really going to get from the surgery. I would ask up front if they will give you the IOL Calculation sheet.
    3. I would find out what instruments the surgeon uses or pushes. Some will not do surgery without using a laser to make the incision, which really only adds cost. However to get the best results look for a surgeon that uses the IOLMaster 700 instrument to measure your eyes, and the Pentacam to map the topology of the cornea. They will give you the best results when it comes time to make the decision about power and whether or not a toric lens is needed. Corners can be cut by doing an ultrasonic eye measurement instead of the optical method used by the IOLMaster, and by skipping the Pentacam topography. I would not do it. That is not where you want to save money. You want the best measurements possible.
    4. To minimize costs I would pass on the toric lens if cylinder is predicted to be less than -0.75 D. In Canada a basic monofocal toric costs $1,100 more than a monofocal only per eye. May be more in the US. To some degree the sphere power of the IOL can compensate for smaller amounts of astigmatism even if it is predicted to be in the -0.75 D range.
    5. I would discount the value of "rock star reputation", other than for bedside manner. It is not good to get a surgeon that is an arrogant know it all. You want one that you can talk to, even if you know it all. That can make them even more difficult to talk to. Some can "get their back up" instantly if they think you are second guessing their ability and advice.
    6. I would pick a surgeon that does the day after surgery exam as a minimum, but I see nothing wrong with leaving the 1 week after and 3 weeks after exam to a trusted optometrist. That may save you some money. And, I like the idea of having the exam done by an optometrist independent of the clinic where the surgery has been done. They are more likely to give you the straight goods on where you ended up.

      .

      Hope that helps some,

    • Dapperdan7
      Dapperdan7 RonAKA

      Posted

      as usual, u give me much valuable info ron.

      question: "predicted astigmatism" . what exactly does that mean? i have 1.0 and 1.25 cylinder respectably. and , would u recommend a toric?

      thank u sir

    • RonAKA
      RonAKA Dapperdan7

      Posted

      Am I correct in assuming those cylinder numbers are from an eyeglass prescription? If so, then you need more information before you can make a decision. When you get the IOLMaster 700 readings, and the Pentacam scan, only then will you know what the predicted cylinder will be after surgery.

      .

      The problem is that an eyeglass cylinder number is what is required to correct astigmatism in both the natural lens plus the astigmatism in the cornea. Since cataract surgery is the complete removal of the natural lens, that component is gone. You only have to correct the astigmatism in the cornea. That is what the Pentacam measures.

      .

      That prediction of residual astigmatism will be on the IOL Calculation sheet. Once you have that in front of you then you can make a decision about needing a toric lens or not. Based on the eyeglass prescription it is possible you may not need a toric, but you need the measurements to know for sure.

    • Dapperdan7
      Dapperdan7 RonAKA

      Posted

      is that also true for a contact lens prescription?

    • RonAKA
      RonAKA Dapperdan7

      Posted

      Yes, essentially the same issue. A contact lens is making the total correction for astigmatism in the cornea plus natural lens. You need to know the astigmatism in the cornea only to determine if a toric is warranted or not. And, a toric is only needed if you want to be eyeglasses free. If you are going to wear glasses then there is no need for a toric lens, as the lens can correct astigmatism just as well or better than a toric IOL.

    • Dapperdan7
      Dapperdan7 RonAKA

      Posted

      so if the astigmatism is only in the lens, not the cornea, a toric iol is not needed, correct?

    • RonAKA
      RonAKA Dapperdan7

      Posted

      Yes. If you only have astigmatism in the lens, it will be gone after cataract surgery, except for the amount of astigmatism which may be induced by the cataract incision and the way it heals. That is kind of dependent on the skill of the surgeon, but that alone should never be enough to warrant a toric lens.

      .

      This said the real world is not that simple. The eyeglass (and contact) astigmatism correction is the vector sum of the astigmatism in the cornea and the lens. This astigmatism can be offsetting if they are at different angles so that the astigmatism in the cornea is being reduced by the astigmatism in the lens. Then when the lens is removed the total astigmatism goes up. In the other case if they are both at a similar angle in the eye, then astigmatism is additive and when the lens is removed the total goes down.

      .

      That is why you really don't know the after surgery astigmatism potential until the detailed eye measurements and topography is done.

    • Dapperdan7
      Dapperdan7 RonAKA

      Posted

      so the new opthamologist has the alcon argos biometer as opposed to the iol master 700. they tell me it is state of the art. have you any input as to how this system compares to the 700?

      thx

    • julie66167
      julie66167 RonAKA

      Posted

      How do you find out how many cataract surgeries and ophthalmologist does in a year? Do you simply ask them?

    • RonAKA
      RonAKA julie66167

      Posted

      Probably asking them is the most direct way. If they are a private style clinic they may have a website promoting the credentials of the surgeons. That certainly is the case with Lasik. They all seem to like to promote how many thousands of procedures they have done. The guy that did my eyes and those of my wife operates 2-3 days a week and does about 25 in a day. I think the prime thing is that they are doing them as their main area of practice, and what they have for equipment. My surgeon transitioned from operating out of a fully equipped hospital to having a private clinic as well in the time between my first eye and my second eye. The equipment sophistication went down in his private clinic, which I believe he inherited from his father. For example it had a IOLMaster 500 instead of the IOLMaster 700 which was in the hospital. And, in his private clinic he did not seem to have the ability to display the topographical map of the cornea, but did in the hospital. Fortunately my eyes were measured both in the hospital and in his clinic and he had access to both.

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