Cash Pay Surgical Centers and My Knee Surgery

About four years ago I took this picture with Keith Smith MD when he came to Charlottesville, Virginia.  It is about an hour and a half from my house but there was a new cash pay facility called the Monticello Community Surgical Center opening up there.  I listened to the talk by Keith and the FMMA (Free Market Medical Association) and was impressed.  Fast forward to Thursday where I decided to have my knee scoped at this same center. But why did I do this?

In November of 2016, at the age of 51, I had to have a total knee replacement.  A college wrestling injury led to 4 arthroscopic surgeries and 2 ACL repairs but the joint had finally given out.  I had my TKR here in Lynchburg and it was a brutal recovery.  The three months following the surgery consisted of no sleep and intense pain. Sixteen months later and I am having tremendous pain again with very loud crepitus with this same knee.  I thought I had something called Patellar Clunk Syndrome, which meant more surgery.  Here is the interesting part.  The local and ONLY health insurance option (Piedmont) offered a plan for $1800 a month for my wife and daughter and myself.  This was ridiculous so I went with Liberty Health Share for $480 a month.  The problem is that they were not going to cover the knee for a few years as it is a pre-existing condition (you get more coverage on these conditions each year with the plan) so I needed a cash price.

I called the local orthopedist who did my surgery and personally asked if he would get me that price.  He said he would get back to me.  A week later and nothing.  After badgering them some more his staff finally gave us “his” price but we would have to find the anesthesiologist’s price and the facility price on our own.  You have got to love this type of customer service technique.  And I am a colleague!  Add to this that they (the orthopedist, the anesthesiologist and the surgical suite) are ALL housed in the same place yet I would have to do all the work in getting a quote.  That’s when I thought about Keith Smith again and went back to C’ville where the facility was cash pay transparent just like his in Oklahoma.  For $3740 I had the consult and full surgery done.  It was that simple.   For those that want to know, I had severe arthrofibrosis in the TKR.  There was supposedly five times more scarring than the orthopedist, who did the surgery, had ever seen before.  It was even growing into the TKR prosthesis itself (if anyone has any idea why this happened please tell me even if it was due to the last ortho’s work. I really need to know).

Right now I am sore and at home recovering.  I am happy with my decision to go to the cash pay facility.  When you think about it, the cost of using regular insurance probably would have been more than $3740 and with a $6K deductible, I would have hit that easily.  The system is so screwed up.  What other business are you UNABLE to get a cash price for something?  The local orthopedic facility never got back to me and the orthopedist doesn’t even know that I had more surgery.  I am embarrassed that professional courtesy rarely exists anymore.  Imagine how patients, who are not doctors, feel?  We can do better.  We need to do better.

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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  12 comments for “Cash Pay Surgical Centers and My Knee Surgery

  1. Mamadoc
    February 22, 2018 at 10:55 pm

    Not getting in the middle of this but hope you feel better soon.

  2. JRDO
    February 17, 2018 at 9:47 am

    Doug, I am delighted you had a good experience and hope that the result of your latest knee surgery is excellent.

    A number of years ago I had an unemployed patient who was unable to work at his profession as a framing carpenter due to a bum knee. He was basically flat broke because of the knee and didn’t qualify for Medicaid because his wife has a near minimum wage, no benefits job as a home health aid. The ACA had just been recently passed and he was able to get insurance on (heavily subsided of course) and I was therefore was able to arrange for him to have a TKA which was very successful. He is now back to work and paying his taxes. Without the insurance he would have ended up on government disability.

    I agree wholeheartedly that insurance companies suck, but my patient never would have been able to afford the very reasonable cash price that you paid for your surgery- let alone a TKA. How do you propose that someone like him would get the care he needed to keep off the dole without insurance to get him over the hump? I can think of many other expensive items as well, for instance pharmaceuticals such as Enbrel, which I have the same concerns about.

    • Doug Farrago
      February 17, 2018 at 12:15 pm

      There has to be some safety net for people of his income

      • JRDO
        February 17, 2018 at 3:02 pm

        Which is exactly what Obamacare is/was. It’s for the minority of us who don’t have insurance via our employer or qualify for government insurance (Medicaid or Medicare). I certainly think there are tweaks that should be made to make it better, and I’m all ears for hearing about alternatives, but DPC/Cash/Free Markets/ High Deductible Insurance Plans don’t fill the need for major medical expenses for the working poor. What am I missing?

        • Doug Farrago
          February 17, 2018 at 4:28 pm

          Your missing the point about the nontransparent high prices the government has created and how DPC/Free markets bring them down.

          • JRDO
            February 18, 2018 at 9:37 am

            I’m not bashing DPC/Free Markets- there are a lot a benefits. But even with the benefits of DPC/Free markets there are many patients like mine with the bum knee that can’t afford to participate. You said there needs to be “some safety net”. If not insurance, then what? Certainly it has to be some form of government insurance because private insurances/free markets aren’t going to volunteer to step up and take a loss. Expand Medicaid? That was the part of the ACA which put the onus on the states. I’m looking for a better way to do the safety net and would like to hear more specific detailed ideas.

          • Doug Farrago
            February 18, 2018 at 10:13 am

            Medicaid is the safety net for the poor and should continue, IMHO, but not expanded. I am not going to lay out a specific plan (you can search this site for things I have said over and over). I would like for a real free market system to help bring prices down so bum knees can be fixed at a reasonable price so your patient can afford it. And pay for it.

        • Pat
          February 17, 2018 at 6:11 pm

          Disagree completely. The ACA only worsened the existing problems, AND paid a huge sop to Big Insurance. It “insured” more, without demonstrably improving access to care. Your first point was a thoughtful one; trying do defend the corrupt-from-the-start ACA has been disproven by its own track record.
          There should be a safety net, but at the state level. Otherwise we’re just trying to make ourselves feel better by pursuing nationalized health care without solving a thing.

        • CHRIS
          February 19, 2018 at 12:38 pm

          Actually it was not. The ACA shoehorned the uninsurables into the insured market. There was a reason they were uninsurable, and we have seen the result for the rest of us in skyrocketing premiums and deductables. In fact there has been a ton of debate on whether just providing fully government funded coverage to the uninsurables would have been cheaper for the government than the ACA and spared us all having our premiums and deductables skyrocket to boot.

  3. Dr Bonz
    February 17, 2018 at 9:43 am

    It is obviously insane that you would have had to both pay for your insurance AND the deductible and find out that the cash price was actually less. If that’s the case, why do we even buy insurance in the first place. However, you shouldn’t be so hard on the orthopedic surgeon. Him not being able to give you the price for the facility or the anesthesiologist is no different than your plumber not being able to give you the price for your electrician and your bricklayer on a construction project. The coding (as I’m sure you know) is ridiculously complex and it has become hard enough for me to know my own codes much less the codes of colleagues. Also, if you are an employed surgeon (unfortunately I am) you CANNOT give professional courtesy! This (among many other things) is one of the worst things I dislike about being employed. If my own brother came to see me, I am FORCED to charge him by the hospital system that I work for (this actually happened).

    • Doug Farrago
      February 17, 2018 at 12:17 pm

      Ugh. And I am trying not to be too hard on the surgeon I get the confusion he may have. It was the facility that couldn’t figure it out or be bothered to figure it out.

  4. John Chamberlain
    February 17, 2018 at 9:24 am

    Thanks, Doug for this excellent example of why we need more independent, third party price transparency resources (not those sponsored or promoted by the insurance cartel) and more freestanding price transparent surgery centers.

    Bravo to you for choosing one and for choosing to go with Liberty Health Share!

Comments are closed.