“You have a couple of options,” said the surgeon, Dr. Mitchum. We talked over the phone: he in Minnesota, me in Germany. “It depends on your tolerance for risk. We can do a partial takedown. That’s easy enough. Or we can try to fix the wrap.”
The wrap was the fundoplication surgery I had received 14 months earlier.
“That would entail a complete takedown, right?”
I sat at my aunt’s dining table, one hand clutching my forehead. Tante Edelgarde was already in bed; the rest of the house was dark. It was 11:30 at night. The village was dead quiet. In mid-afternoon Minnesota, the surgeon’s voice had the brightness of daytime.
“Right, and it would put your vagus nerve at risk. The posterior stitches are harder to get at; I’ll be digging around back there and so there’s a danger I’ll nick the nerve. I’m not saying I can’t do it. It’s just that you need to know the danger.”
“My current surgeon told me that my vagus nerve is stressed from the first surgery and that’s why I’m getting the bloating and gas.”
“In my experience the vagus nerve is either working fine or broken. There’s no in between. And your gastric empyting test was fine, you said.”
“If we just remove the anterior stitches — which is easy enough — it should relieve the pressure.”
“And then I’m back to heartburn.”
“You still might get some therapeutic benefit from the wrap at 90 degrees.”
“Look, I’m interested. It’s a little crazy, though, that I would fly all the way to Minnesota for surgery.”
“Well, we’re in a nice little town.”
“Yep, if you’ve ever seen that Coen brothers movie, it’s near Fargo.”
“Pretty accurate about the winters.”
“So it’s not close to Minneapolis?”
“Oh no, in fact you layover in Minneapolis and then you take one of those little regional prop jets over to Brainerd.”
“We’re about 15 minutes by car from Brainerd.”
“Of course, this is way outside my network. I’m going to have to pay out of pocket. What’s this all going to cost?”
“Let me tell you, this is what you do. You need to negotiate. There’s my fee and the hospital’s fee. I’ll tell Sally to find out what my fee is — I don’t even know, it depends on the codes — and what the hospital’s part is going to cost and then you have to negotiate. Negotiate my fee, too. Tell them that you’ll be paying cash, up front.”
“Christ. It’s like I’m buying a car.”
“I know. Health care has become like a commodity.”
Minnesotans are slow. It took two weeks to get an estimated cost for Dr. Mitchum’s fee. $3,300.
“That’s with a discount,” said Sally, the surgery aide.
It didn’t seem too bad. I had expected worse. So I didn’t try to negotiate it down. Meanwhile, the hospital took another week to come up with their price. When they did, Sally called me again.
“Ok David, well first, we had the surgeon’s fee wrong.”
“It’s actually going to be $2,800.”
“Yes, it’s gone down.”
“Does that ever happen?” Dr. Mitchum might have taken pity on me.
“I don’t know. Now, we heard from the hospital.”
I heard Sally take a breath. A deep one.
“Their fee for the surgery is, um, $14,000.”
“What? You’re kidding me! Really? That much?”
“Yes, but with the regular discount they give private patients it comes down by 35%, and if you pay the whole thing at one time, they take another 20% off. That will bring it down to about $8,000.”
“That’s still a lot of money, Sally.”
“I know. It is.”
“Is there anybody I can call over there? Dr. Mitchum told me to negotiate.”
Sally gave me a name and a number of a man known as Karl. So I called Karl.
“You see, these are standard discounts we give uninsured patients,” Karl said. “It’s mandated by law. We have contractual obligations. There’s the 35% discount; it’s what we give our preferred insurance carriers. And then if you pay up front, another 25%.”
“And you can’t do any better than that? I will pay you in cash up front. No waiting for the insurance company to pay you — you’ll get the float. And no paperwork. That’s a tangible benefit.”
“No, it’s all regulated. If we gave you a bigger discount, it would would mean we were breaking the law.” Karl chuckled; even he didn’t believe what he had just said.
“I don’t know.”
“Look, that quoted cost is just an estimate. And it’s a high one. The amount is based on time — how long a procedure takes. I looked in our files for the last time we did this and that’s how I came up with the number.”
“Was that for a full or a partial takedown?”
“Ah, see I’m going to get a partial takedown. Would it be possible for you to talk to Dr. Mitchum to see how long that would take and then come back to me with a new estimate?”
“Sure, I can do that.”
“Because I really want to get this thing done,” I said. “And at your hospital, because I respect Dr. Mitchum and the work you do there. I don’t want to have to take this surgery somewhere else. And I want to get this done as soon as possible.”
“Well, now’s the time, David, before the winter comes. We have rough winters.” He laughed quietly. “Rough winters.”
Another week went by until Karl and I talked again.
“David,” he began, “I can offer you a new price, in which you’ll pay the hospital no more than $5,600. That’s the best we can do.”
I thought about it for a moment; I wondered again if the hand of Dr. Mitchum had intervened on my behalf.
“OK, Karl, let’s do it. So what are my next steps?”
“Call Dr. Mitchum’s office and schedule the surgery.”
“And If I’m lucky I can get it done this month.”
“It would be the perfect time. You want to do it before winter sets in.”
“Karl, it already has.”