June 11, 2010
My Achilles Story in Numbers: A Chronology of Expenses
Posted by booklady under Uncategorized
My son’s college financial aid advisor thought our out-of-pocket expenses for my injury was important information to include on his FAFSA application, so I set out to find out how much my injury cost.
Though I am fortunate enough to have good medical insurance that covered 90 percent of my expenses, the final amount was still jaw- dropping. My 10 percent co-share was significant to cause a major dent in our family budget. The final tally does not include Flexible Spending Allowance (FSA) items such as bandages, cast covers and shower chairs, nor does it include mileage for the numerous doctor visits or other inconveniences such as new shoes that don’t chafe at the incision.
My case is a bit unique because I suffered a major infection and had two surgeries:
- Emergency Room Visit 1,574.34
- First visit to Ortho 329.84
- Surgery (Ortho, Anesthesiologist, O/R) 10,027.66
- Ortho casting and office visits 1,940.70
- First round of physical therapy 748.70
- Series of blood work to determine infection 401.50
- Miscellaneous antibiotic prescriptions 559.94
- Office visits to Infectious Disease Specialist 708.96
- Intravenous Cathether installed 5,222.04
- IV Therapy including drugs & a home nurse 20,551.90
- Weekly lab work to monitor infection 557.10
- ID Specialist ongoing office visits 921.44
- Second opinion of another ortho 196.85
- MRI of ankle and heel 3,983.00
- Second surgery: Debridement 13,048.07
- Post-Op ortho visit 233.08
- Final ID Specialist visit 115.18
- Second round of physical therapy 1,903.56
TOTAL $52,400.95
10 percent out of pocket $5,240.00
Being able to walk priceless
June 11th, 2010 at 10:38 am
Wow! I wonder if we’ll live long enough to see Insurers resisting ATR surgery, based on the results of the randomized trials (now FOUR of them!) — and the lopsided costs. Most patients aren’t anywhere near informed enough by hurry-up decision time to get to the bottom of the evidence, so that’s been a pretty slow way to save the world.
I also wonder how much of the “Ortho casting and office visits 1,940.70″ would have been saved with a $150 boot — an investment that also gives patient-side BENEFITS!
Here at AchillesBlog, we’ve got a few “crusaders” for non-op treatment, and we’re coming from two different places. A few of us are happy consumers of non-op treatment, and one or two others are people who’ve suffered from surgical complications and wished they’d been shown the evidence before they got the surgery.
We’ve got LOTS of crusaders for boots instead of casts.
June 11th, 2010 at 9:06 pm
Wow +1
I’m with HMO / Kaiser
each visit to doctor or pt cost me $20.
I didn’t get MRI
I see you had MRI - was it any useful?
Was you able to see your MRI results and understand it?
Was it just one MRI or many?
June 12th, 2010 at 12:50 pm
Hi Norm –
You bring up the important point of having enough evidence to make an informed decision.
In considering my age and physical activity level, going non-surgically meant spending more time in a cast and the possibility of a re-rupture. I was training for the Honolulu Marathon which was in a few weeks at that time. Though I accepted that I needed to drop out of the race, spending more time unable to be active was as traumatic as the rupture itself.
Going the surgical route would allow the ortho to see what he needed to deal with. We discussed the risks and realities of infection, we talked about his experience with ankle surgeries, and what to expect of recovery. I opted for surgery with my eyes wide open.
During the operation, the doctor discovered that my tendon was in a very poor condition, with it stretched and torn three times as wide. We would not have known this had we gone the non-surgical route and this would increase my susceptibility to another rupture and after having given all that time in a cast.
In all, I wanted to heal, and to heal quickly. There are no guarantees with infection, and I took that risk and lost. Perhaps having more sutures than normal to fix my deteriorated tendon added, but I could have picked up a bug anywhere. Having a huge incision on my ankle just gave a larger entry.
Would I do this again? I’m not sure, given my tendon condition. I would probably try the non-surgical route and force myself to give the time for recovery. The life-threatening state that the infections brought were very serious, and there would have been fewer options if the IV therapy did not work.
Your advocacy for the non-surgical route makes a lot of sense. As one who has gone the opposite of where you are, an ATR patient can consider my experience when needing to make a decision.
~booklady
June 12th, 2010 at 1:10 pm
Hi Mike –
Yes, I had the same response myself when I added the figures. I wonder if I would have taken the same options if I were with an HMO . . .
My MRI was taken to confirm if I needed a second surgery. I had an ankle and foot MRI because one option was to replace my achilles with the tendon from my big toe. This procedure would be my last resort.
My other option was a debridement. I was allergic to Ethilon,the suture material used to stitch the tendon. My body was rejecting any foreign material, thereby causing the infections.
I was able to see my results after an interpretation. There were about 40 sheets. Having the MRIs were useful in the sense that they gave information on the extent of my tendon’s bad condition and what needed to be corrected.
Hope you are recovering well –
~booklady
June 12th, 2010 at 1:37 pm
Booklady, you’ve given all the “logical” reasons why the surgical cure should be producing better results on a random population than the non-surgical cure — except it doesn’t!
And you may well have been told that the non-surgical cure takes longer, but it generally doesn’t, although way too many “experts” and web-sites still say it does. In fact, the last 4 studies comparing the two approaches used exactly the same rehab protocol, and that protocol is FASTER than maybe 90% of the surgical patients who blog here! (When I’m not ranting against ATR surgery, I’m ranting to get post-op patients out of their NWB casts and onto “my” faster protocol — the one that I’ve followed WITHOUT surgery!!)
The unusual condition of your AT may mean that you were the “oddball” exception who should have done better with surgery (without complications). But if that kind of tendon condition showed up in even 5-10% of ATR patients, we’d expect it to produce an overall benefit on the surgical side that would show up in the statistics. But no.
I find all these anecdotal descriptions (including MRI and Ultrasound readings — including my OWN!) confusing and uncertain, while I find the overall statistical results clear and persuasive. Of course, none of us is a statistic, and 1 in a million chance of a terrible outcome is too high if you’re the 1!
Meanwhile, there are still way too many infections in most hospitals, and the new evidence on THAT subject shows that virtually all of them are preventable. And they are being prevented in the smarter institutions — or those who have lost a lawsuit over one.
Regulations forcing hospitals simply to PUBLISH their infection rates are an obvious and powerful tool that is saving lives where it’s been implemented.
June 13th, 2010 at 11:08 pm
thank you for answers
wish you fast recovery