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The Costs and Benefits of Treating Sinus Problems via Conventional vs. Functional Medicine
Sat, 03/23/2013 - 11:50am
I received the letter, below, from a proactive medical consumer wanting to have her experience as a medical consumer go toward helping those who would learn about it on Lumigrate: medical providers AND other consumers/patients. Nancy, her real name, has been aware of Lumigrate since 2009 and the type of information provided at the website, as well as what I do with suggesting information to people related to connecting them to education and resources individually. So I am very appreciative of her asking me to include "herstory" here. It seemed we were very similar in our beliefs about using a mix of conventional and alternative medical strategies for our personal health care and were similarly concerned about the challenges today for consumers overall and personally. Interestingly, though we didn't discover it until I learned of the incident she shares in her letter, below, we've shared a common medical issue related to sinus problems plaguing us for many years, and even have sought treatment from the same provider, who I was also impressed with and helped by. (As you will read, below, she commends the doctor/surgeon and had a good outcome.) I had been referred by an urgen care physician to The Doctor/Surgeon the first year I lived in Grand Junction; I thankfully got very sick in Telluride when attending the Blues and Brews festival, as I had gone with friends from Colorado Springs the two years before so this was our time to get together still, which was nice to see them for a long weekend (sharing a condo). I was walking around town on Saturday night and felt short of breath but that was the only thing I noticed, and thought 'boy, I've gotten used to being a little lower in Grand Junction'. The next day I woke up and was sick -- really, really sick. So sick I looked down at the hot tub and thought I might not be able to make it back up the stairs if I went and soaked. Thinking about driving back home the next day didn't seem feasible either, so I figured I'd better go to the doctor. The Urgent Care is also the ER there. It turned out to be an ER doctor who also worked in Grand Junction, but I never would have gone to the ER in Grand Junction, I'd have gone to the primary care doctor. So this added a NEW member to my YOU! team. There are different things in the Grand Valley of western Colorado than where I came from on the Front Range, it's easiest to think of pollens, but I'd asked the first chiropractor I met here why there were so many sick people in the Valley, and he said 'the molds'. It's a valley with all kinds of water -- the Colorado River runs through it, junctioning with the Gunnison (yes, I made up a new word!) -- irrigation canals and I've seen copious watering going on where people use that type of water. It can be very humid at times, too .. for the high mountain desert. Man's messing with mother nature, I suspect, has contributed. I'd also like to point out that would include EMFs, electro-magnetic frequencies, which interplay with mold. But I didn't learn all that until I studied it in order to provide information about it on Lumigrate (so you can look for those topics using the search bar if you wish). I had a few years of colds and brochitis or vertigo occurring at the same time each fall and spring, presenting to the primary care physian's office almost on the same day, the astute PA noticed from seeing the notes in my chart. So clearly, since the problem kept going on, the underlying causes had not yet been solved from what treatment I got from the Telluride ER visit, though I believe it was an instrumental and big step, because I repeated the mix of medications she talked me into trying over the next three years, in addition to continuing to learn more in the functional, biologic, integrative medicine realm. I'd not taken enough probiotics -- I came to eventually learn through experts who later came to write on Lumigrate from outside of Grand Junction, that people who've had gut dysbiosis from the myriad of things that cause people to get candida overgrowth in the body simply have to ongoing be doing things to keep the biosphere of the gut 'happy' -- probiotics, fermented foods, and limiting the various forms of sugar we tend to crave. (Mine as a child was fruit, as an adult living in wine country it turned to wine, others it's deserts, candy, etc.) The ER/urgent care physician had educated me that re-curring sinus infections were a result of nasal sinus' having poor blood vasculature, so you take antibiotics and the cutting edge treatment at the time was to prescribe a 'blast' of prednisone at the same time, which took some talking me into doing, but I was pleasantly surprised at the results. And she referred me to an ENT in Grand Junction. Same practice as the one which saw Nancy, whose letter below describes her angering issue about the money end of the procedure she had done. My ENT further educated me about sinus rinses that were new on the market at the time and said that if I had more than a few sinus infections a year the next step would be a CT scan of the head and then possible recommendation for sinus surgery. To me, it seemed that if I didn't start having sinus infections until after I had chronic fatigue and fibromyalgia, that if I could continue to do functional medicine's approach for finding the underlying reasons and addressing those, then reverse the symptoms of those conditions, that I should be able to be free of sinus infections if I kept after it. Since I'd not had any head or face trauma in my adulthood to cause a change in the structure of things that would be changed with surgery, it just seemed that I should be able to make do with how things were naturally. I did end up having the CT scans done by the local holistic dentist, because I became aware from his presentation that I had sleep apnea symptoms showing on my neck as a child (from head forward posture to adapt and get more air in. This is also a symptom of Ehlers-Danlos syndrome, or EDS, and I do not yet know if that is because that tends to have the 'messed up sinuses' that were found on my CT scan or if it's just from the overall issues of the disorder; I believe I have milder forms of two of the types of EDS, thanks to learning on Facebook via groups about methylation problems where I was studying.) I was helped by a jaw positioner for apnea, but it turned out that it kept breaking and needing repairing every month (Silent Nite brand, I'm not a fan of them, they wouldn't make another one at no cost and there's no way I am that hard on them when I'm sleeping, there was something funky about this one and it's a lemon, I think). So thankfully I was also helped by a positioner that was made by the dentist's lab that was for TMJ remediation, and it never needs fixing. I sometimes think that about half of what I've paid for and done helps, and the other half has been a waste or it's been detrimental at times due to 'nobody being perfect' that bordered on incompetence with a couple of providers I've had. Live and learn. But the take home message is that the body is so set up to thrive and overcome that you can do 50/50 and you'll get improvements over time. The trick is to get that percentage up higher with the providers you chose to work with. Hence, I've attempted to find quality providers around the US who work with people remotely, for those areas where there simply aren't great or any providers where they live. I hope that this will be a thought-provoking piece for those reading it, both medical providers and consumers/patients, as it demonstrates the different medical models available for consumers and providers to utilize today, in this case the "conventional medicine model" and the "functional medicine model", or more holistic or biologic are other terms used. And by 'following the money', perhaps it will help all of us learn more about why it is so necessary yet difficult to make the changes in our health care system.
NOTE: The names have been changed to protect the innocent or guilty; our purpose here is not to indict and be a cog in this specific case, Nancy is taking it up directly through the proper channels. Our intention here is to educate people in general about this type of problem going on, what a consumer can do about it, and get as many appropriate providers giving input as possible, so we can all learn and grow as consumers or providers.
I did, however, leave the writer's name intact, as she has agreed to provide follow up and discuss this here in the hopes that it contribues to change overall and helps any individual who is in a similar situation, and to invite people who address her questions the invitation to contribute responses here as well. And so, here is the letter from Nancy Loftholm, of Grand Junction, Colorado. (Wherever I modified a specific name it is italicized and underlined.)
I will begin this letter with some shocking numbers. In November, I had outpatient sinus surgery at The Surgical Center. The billed cost, just for being at the facility for about three hours, totaled $53,262.50. That is about $296 per minute, $17,760 per hour – for a surgery with no complications that lasted under an hour.
My insurance company negotiated a discount and ended up paying $37,512.11. Now, The Hospital wants another $175.89 from me. I am a person who pays my bills, but I am so incensed at The Hospital's price gouging that I cannot bring myself to write the check for this. I have talked to many people, including some in the healthcare industry, about this unbelievable charge. Everyone has been astounded at the amount. They have all encouraged me not to drop this – even though my insurance company paid – because it is such a vivid example of what is wrong with our health care system.
My anger is compounded by the fact that I was trying to be a responsible health care consumer prior to surgery to help keep costs down. On the advice of the surgery scheduler at The ENTs Office, I asked for and received estimates from the various providers involved in the surgery. I used the procedure codes, the estimated surgery time, and the name of my insurance carrier when I asked for estimates. The surgeon’s and the anesthesiologist’s estimates were close to what they ultimately billed.
But The Surgery Center gave me a quote of $6,195 for my surgery. I also called the Another Outpatient Surgery Center. The estimate to have the procedure there was $15,972 to $18,000. Of course, based on those estimates, I decided to have my surgery at The Surgical outpatient center. Now, I feel like the victim of fraud.
When the bill came, I called Jane Doe, the person at The Surgery center who gave me the estimate, but I was diverted to a billing contractor in Another State. He said the bill was not a mistake and gave me various reasons why. They did not add up. One reason was that the procedures were done bilaterally and the estimated cost was for only one side of the sinuses. That would mean a doubling of the bill – not nine times more. The itemized bill I requested showed that the surgery center charged from $5,027 to $6,139 for each of the procedures and another $1,347.50 for “implants” – presumably the plastic bits the surgeon put in my sinus cavities to keep them open.
When I asked the remote billing person how I could prevent being given false estimates from The Hospital in the future, he gave me some lengthy, insurance-speak gobbledygook about how I should call The Hospital and get a tax ID number, then call my insurance company to find out how the company contracts with The Hospital based on that tax number, then give the procedure codes ….etc. etc. Why didn’t the surgery center person who gave me the estimate in the first place mention any of this or reveal that the real cost could be highly inflated?
Bottom line, $53,262 is an absolutely outrageous charge for less than an hour-long outpatient surgery, without complications. And the $37,512.11 my insurance company paid is also out of the realm of anything reasonable. I believe The Surgery Center has made enough profit on this procedure already and should be ashamed of this kind of price gouging – and of trying to extract even a small amount more from me.
On a positive note, the care I received at the surgery center was excellent. Everyone, from the receptionist to the nurses, was very professional. Dr. Surgeon was great. The surgery experience was as comfortable as could be. It was just not worth upwards of $53,000 and, I would think, not worth the kind of black eye this gives The Hospital's outpatient surgery center in a town touted for exemplary healthcare.
Nancy Lofholm
Address
Grand Junction 81506
970-phone #
Progress note as of 3/25 - the Billing Contractor in the Other State has responded with a letter which didn't ultimately answer the question.
Another bill arrived for pathology, which was a surprise as there was to be no tissue removed in the procedure. That provider's office refused to answer what had been studied and deferred the patient/Nancey to inquire with the ENT/surgeon.
Nancy said something about how she's becoming quite a grouch about this process. I had to say I could empathize and I remember going round and round for months with insurance related to my husband's surgery charges, it came down to one item that just didn't seem like something that was necessary. Three times the people I spoke with at the insurance company weren't in the position by the time I followed up again. And the other thing that went through my mind.
This is one person's relatively simple surgery on a canvas background of life which has not had this kind of thing ongoing, as she thankfully has not had 'chronic illness' identified, aside from the symptoms that are sinus focused. Imagine what this is like for people who have ongoing medical problems.
I knew of a woman, also local, who seemed to be extremely healthy who started having some symptoms of concern and sought out a doctor who actually has a closed practice, but she was well connected and got around that. Then when she went to change insurance policies they looked at her records (this is Grand Junction, the EMRs and Health Care Reform grew from seeds planted years and decades ago here) and there was something in the doctor's records that flagged her for being declined. And it was something that just needed to be addressed with the doctor and modified and then the insurance company was fine with it. And she was angry and hurt and frustrated ... I heard about it pretty much every time we conversed, which was on a regular basis at that time .. and I thought of that as a meant-to-be lesson to me to see how much the medical 'hassles' affect overall well-being. I realized a lot of our well-being dysfunction is contributed to by the hassles of just navigating the system! (And by being aware of that, it helps because you can then address it with whatever coping strategy or strategies you use.)
Check back, I'll keep posting about progress if I hear from her. ~~ Mardy
11/13/14 - When I listened to a digital audio file that's downloadable from The Klinghardt Academy, I thought of this thread at Lumigrate. (At the current (old looking) website, go to the "Listen to Dr Klinghardt" tab, and it's the 90 minute one that's at the very bottom, there are only a handful there, two are about autism. I've now listened to them all and they're all very good and worth listening to as they reinforce the information. Another is about the five healing aspects. This is a comprehensive one that's about the overall, but the interviewer asks specifically about sinuses and molds/ biotoxins and etc. Plus he talks about the transgenerational trauma that affects the generations after the person who had the psychological trauma, and this is something very much overlooked by others typically and I think is very unique and important when looking at things from a mind, body, spirit / integrative medicine perspective.
I'd just seen another local woman turning to her FB friends for suggestions about how she again has a cold, and asking for suggestions -- and added that she's pretty sure her sinuses are messed up too, and asking for doctor suggestions as well. I suggested the ND who is local and was the first ND I had content from on Lumigrate, way back when we launched with just the local providers who had for a short time collaborated (myself included) at a new integrative center. AND naturally there are the remote providers that people can utilize now, I try to find some providers to link from topics at Lumigrate who advise remotely, as a small city like Grand Junction is sometimes limited in options .. and many people live in even more 'rural' places, OR they're in the city but they don't know how to find the kinds of providers they're looking for and they're just as happy to do remote as make the trip physically to see a provider. I'm surely appreciative of the contacts for a length of time from one city that I've been in for 11 years now, and seeing 'the overlap' with women my age ... I unfortunately have more company in the "Knows She Has Chronic Conditions" boat! Sadly, I had never been totally 'well' as a child, though I did get 100% well in terms of functional level, but we'd not gotten to solving the underlying problems totally. I'd gotten things 'knocked down' enough with aggressive diet, exercise, and other lifestyle changes, but then when I went back to doing more 'normal things', then things slid again. And I also got another vaccination when I started back to university -- so many factors and it's impossible at first to see the correlations maybe. Over time you start to see the dots connect. Sometimes there'll be a dot that did not connect and then you hear something said and think 'oh, that could be what caused THAT way back when'. ... I've had SEVERAL of those from becoming a fan of Dr Klinghardt's work and listening, watching, reading a lot of the materials I could find. I've even provided transcribed versions and overviews of some of the things so that people at Lumigrate can look over / read / refer. (So look around more (that's what the Search bar's for)...
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Live and Learn. Learn and Live Better! is my motto. I'm Mardy Ross, and I founded Lumigrate in 2008 after a career as an occupational therapist with a background in health education and environmental research program administration. Today I function as the desk clerk for short questions people have, as well as 'concierge' services offered for those who want a thorough exploration of their health history and direction to resources likely to progress their health according to their goals. Contact Us comes to me, so please do if you have questions or comments. Lumigrate is "Lighting the Path to Health and Well-Being" for increasing numbers of people. Follow us on social networking sites such as: Twitter: http://twitter.com/lumigrate and Facebook. (There is my personal page and several Lumigrate pages. For those interested in "groovy" local education and networking for those uniquely talented LumiGRATE experts located in my own back yard, "LumiGRATE Groove of the Grand Valley" is a Facebook page to join. (Many who have joined are beyond our area but like to see the Groovy information! We not only have FUN, we are learning about other providers we can be referring patients to and 'wearing a groove' to each other's doors -- or websites/home offices!) By covering some of the things we do, including case examples, it reinforces the concepts at Lumigrate.com as well as making YOU feel that you're part of a community. Which you ARE at Lumigrate!
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